Iron

Abstract

Porphyria cutanea tarda due to iron overload: case report A 61-year-old woman developed porphyria cutanea tarda (PCT) due to iron overload during treatment with iron for anaemia. The woman, who had a history of anaemia with chronic kidney disease and end-stage renal disease, presented to the emergency room with a blistering rash on her fingers and associated pruritus. Therefore, the woman was treated with prednisone, triamcinolone and diphenhydramine. However, she again presented to the emergency department for worsening rash, which involved the face at this time. She was admitted to hospital. Upon admission, a punch biopsy revealed thick homogeneous disposition within the walls of superficial dermal vessels of IgG, IgA and fibrinogen, suggestive of PCT. Subsequent examination revealed elevated total porphyrins and uroporphyrin levels. Due to her medical history of anaemia, and regular iron [dosage and route not stated] and erythropoietin infusions every 2 weeks, her previous iron studies were reviewed. Iron studies 2 weeks prior to symptom onset revealed a high ferritin level and total iron binding capacity. MRI of the liver revealed iron overload, steatosis and high iron overload in the spleen. A porphyria genome report revealed that she had a rare heterozygous nonsense mutation of the UROD gene. Based on these examinations, it was concluded that iron overload due to iron use triggered PCT. Therefore, she was treated with hydroxychloroquine. Meanwhile, her erythropoietin dose was increased and she was started on deferoxamine. Regular iron infusions with haemodialysis was discontinued to prevent further iron overload [duration of treatment to reaction onset and outcome not stated].