A Case of Secondary Porphyrinopathy Induced by Chronic Alcoholism

Lim, Hee Jin; Kim, Hei Sung; Kim, Hyung Ok; Park, Young Min

Abstract

The disturbance of porphyrin metabolism is principally differentiated into the porphyrias and secondary porphyrinopathies. Alcohol, drugs, heavy metal, and various diseases can cause secondary porphyrinopathy. Among them, alcohol is a major porphyrinogenic agent, and it may cause disturbances in the porphyrin metabolism, resulting in the biochemical and clinical manifestations of porphyria. We herein report on a case of secondary porphyrinopathy caused by long-term ingestion of alcohol in a 47-year-old man. He presented with painful, multiple bullae and erosion with erythematous patches on the dorsal side of both hands and arms, along with periorbital erythema and hyperpigmentation. The laboratory evaluation revealed a slight increase in urine uroproporphyrin without any abnormalities of the heme metabolites. Histopathological examination showed subepidermal bullae and vascular dilatation in the upper dermis. Periodic acid-Schiff stain revealed a mild degree of thickening of the vessel walls and the floor of the bullae. Based on these clinical, laboratory and histopathological findings, we diagnosed this case as secondary prophyrinopathy rather than porphyria.