Porphyria cutanea tarda and sarcoidosis

A 38-year-old black woman presented with a multisystem disease characterized by malaise, fever, sweats, and diffuse hyperpigmentation. Laboratory examinations showed anemia, elevated alkaline phosphatase, granulomas in the liver and bone marrow, and elevated porphyrins in the urine and feces, characteristic of porphyria cutanea tarda (PCT). A workup for an etiology of the granulomas was nonproductive, and the patient responded to systemic steroids.