ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2587

A Case of Porphyria Cutanea Tarda After Kidney Transplant

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Hartley, Robert C., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Al-Rabadi, Laith, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Shihab, Fuad S., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Raghavan, Divya, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Introduction

Porphyria cutanea tarda (PCT) is the most common subtype of porphyria and can be associated with kidney failure with reports of kidney transplantation curing the disease. We report the case of a patient who had previously undergone kidney transplantation and developed PCT after transplant.

Case Description

A 40-year-old man with end stage renal disease due to unknown chronic glomerulonephritis status post kidney transplant 4.5 years ago was admitted with non-healing blisters on both hands. Patient initially presented one month earlier with similar symptoms and was diagnosed with bullous impetigo due to methicillin resistance staphylococcus aureus. At that time, he was treated with vancomycin followed by trimethoprim-sulfamethoxazole (TMP-SMX) for a total of 14 days. He was also noted to have cytomegalovirus viremia which was treated with valganciclovir. Patient reported ongoing development of lesions despite antibiotic treatment and presented for follow-up where he was noted to have an acute kidney injury and hyperkalemia. At presentation his medications included mycophenolate sodium, tacrolimus, prednisone, triamcinolone cream and mupirocin ointment. There was no family history of skin disease and he did not drink alcohol. He underwent skin biopsy which was consistent with porphyria or pseudoporphyria. Urine and plasma porphyrins were checked showing elevated uroporphyrin and also elevate heptacarboxyl, hexacarboxyl and pentacarboxyl porphyrins with normal coproporphyrin I and III consistent with PCT. Additional workup was notable for a ferritin of 978 ng/mL, hepatitis A, B and C titers inconsistent with current or past infection and HFE gene testing showing the absence of mutations C282Y, H63D and S65C. Patient’s kidney injury resolved with cessation of TMP-SMX and fluid resuscitation. Patient was treated with therapeutic phlebotomy and erythropoiesis stimulating agents along with counseling on sunscreen use and wearing sun protective clothing.

Discussion

PCT is the most common form of porphyria and is associated with hepatitis C, iron overload, estrogen administration and alcohol use. It has also been associated with hemodialysis often with resolution at the time of kidney transplantation. However, elevated iron stores are often present in kidney transplant patients and PCT can be misdiagnosed as bullous impetigo as it was in this case.