Tags

Type your tag names separated by a space and hit enter

[Porphyria cutanea tarda revealed by voriconazole].
Ann Dermatol Venereol. 2010 Jan; 137(1):36-9.AD

Abstract

BACKGROUND

Voriconazole is a systemic antifungal drug that can induce phototoxic reactions suggestive of porphyria cutanea tarda (PCT); however, porphyrin levels in urine, blood and stool remain within the normal range. Superficial cheilitis is frequently associated with this clinical picture; it is believed to be related to drug-induced impairment of endogenous retinoid metabolism. We report a case of true PCT associated with cheilitis, both occurring soon after the introduction of voriconazole and partially disappearing after withdrawal of this drug.

CASE REPORT

A 65-year-old man with a past history of excessive alcohol consumption presented with typical features of PCT associated with a mild superficial desquamating cheilitis. Both symptoms had appeared 12 days after initiation of oral voriconazole for a cavitary aspergillosis. Laboratory tests confirmed a sporadic case of PCT. Withdrawal of voriconazole (replaced by itraconazole) resulted in complete disappearance of the cheilitis but incomplete remission of the PCT. Ultimately, the patient was successfully treated by venous puncture.

DISCUSSION

This patient had both voriconazole-induced superficial cheilitis and a true PCT which seemed related to the same drug. The mechanism by which voriconazole may have revealed PCT remains elusive and could possibly have involved decreased uroporphyrinogen decarboxylase activity in the liver or potentiation of the phototoxic effects of porphyrins by the cutaneous toxicity of voriconazole.

CONCLUSION

On presentation of a clinical picture of PCT-like photosensitivity in a patient on voriconazole, laboratory investigations should be performed routinely to rule out true PCT, even in cases of associated cheilitis.

Authors+Show Affiliations

Service de dermatologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

fre

PubMed ID

20110066

Citation

Hickman, G, et al. "[Porphyria Cutanea Tarda Revealed By Voriconazole]." Annales De Dermatologie Et De Venereologie, vol. 137, no. 1, 2010, pp. 36-9.
Hickman G, Duval A, Picard C, et al. [Porphyria cutanea tarda revealed by voriconazole]. Ann Dermatol Venereol. 2010;137(1):36-9.
Hickman, G., Duval, A., Picard, C., & Petit, A. (2010). [Porphyria cutanea tarda revealed by voriconazole]. Annales De Dermatologie Et De Venereologie, 137(1), 36-9. https://doi.org/10.1016/j.annder.2009.10.179
Hickman G, et al. [Porphyria Cutanea Tarda Revealed By Voriconazole]. Ann Dermatol Venereol. 2010;137(1):36-9. PubMed PMID: 20110066.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Porphyria cutanea tarda revealed by voriconazole]. AU - Hickman,G, AU - Duval,A, AU - Picard,C, AU - Petit,A, Y1 - 2009/11/11/ PY - 2009/03/03/received PY - 2009/07/24/accepted PY - 2010/1/30/entrez PY - 2010/1/30/pubmed PY - 2010/4/24/medline SP - 36 EP - 9 JF - Annales de dermatologie et de venereologie JO - Ann Dermatol Venereol VL - 137 IS - 1 N2 - BACKGROUND: Voriconazole is a systemic antifungal drug that can induce phototoxic reactions suggestive of porphyria cutanea tarda (PCT); however, porphyrin levels in urine, blood and stool remain within the normal range. Superficial cheilitis is frequently associated with this clinical picture; it is believed to be related to drug-induced impairment of endogenous retinoid metabolism. We report a case of true PCT associated with cheilitis, both occurring soon after the introduction of voriconazole and partially disappearing after withdrawal of this drug. CASE REPORT: A 65-year-old man with a past history of excessive alcohol consumption presented with typical features of PCT associated with a mild superficial desquamating cheilitis. Both symptoms had appeared 12 days after initiation of oral voriconazole for a cavitary aspergillosis. Laboratory tests confirmed a sporadic case of PCT. Withdrawal of voriconazole (replaced by itraconazole) resulted in complete disappearance of the cheilitis but incomplete remission of the PCT. Ultimately, the patient was successfully treated by venous puncture. DISCUSSION: This patient had both voriconazole-induced superficial cheilitis and a true PCT which seemed related to the same drug. The mechanism by which voriconazole may have revealed PCT remains elusive and could possibly have involved decreased uroporphyrinogen decarboxylase activity in the liver or potentiation of the phototoxic effects of porphyrins by the cutaneous toxicity of voriconazole. CONCLUSION: On presentation of a clinical picture of PCT-like photosensitivity in a patient on voriconazole, laboratory investigations should be performed routinely to rule out true PCT, even in cases of associated cheilitis. SN - 0151-9638 UR - https://www.unboundmedicine.com/medline/citation/20110066/[Porphyria_cutanea_tarda_revealed_by_voriconazole]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0151-9638(09)00610-3 DB - PRIME DP - Unbound Medicine ER -