Porphyria: genetic and acquired

Abstract

The porphyrias can be grouped conveniently by their presenting symptoms. Acute intermittent neurological symptoms of neuritis, abdominal pain and psychoses may occur in acute intermittent porphyria, hereditary coproporphyria and variegata porphyria. Increase of the porphyrin precursors delta-aminolaevulinic acid and porphobilinogen may be observed in the urine during attacks (Watson-Schwartz test). Patients with acute symptoms of photosensitivity with burning pain and oedema within short exposure periods may have erythropoietic protoporphyria, with high erythrocyte and stool protoporphyrins, erythropoietic coproporphyria, and in the last few years of life the more recently described hepatoerythropoietic porphyria. Symptoms of chronic photosensitivity include; hyperpigmentation, hypertrichosis, easy fragility of the skin with bullae and subsequent scarring in porphyria cutanea tarda (PCT), with increased uroporphyrin in the urine and stool; variegate porphyria with increased protoporphyrin and coproporphyrin in the stool; congenital erythropoietic porphyria with an increased copro- and uroporphyrin (isomer I) in the erythrocytes, urine and stool; and hepatoerythropoietic porphyria in later life, in which the chronic features are similar to PCT. In 1913 Meyer-Betz injected himself with 200 mg haematoporphyrin. Initially, at the higher levels, the symptoms were those of solar urticaria as observed in erythropoietic porphyria, but after several months became identical to PCT. A comparison of quantitative porphyrin analysis (performed on 323 patients with porphyria) and chromatography provides additional confirmation for the diagnosis.