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Paez Soria EA, Cremona FA, Lucero Saá F, Chiaradía P. Scleral Compromise in Hereditary Porphyria Cutanea Tarda. J Curr Ophthalmol 2021; 33:91-94. [PMID: 34084964 PMCID: PMC8102938 DOI: 10.4103/joco.joco_119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/26/2020] [Accepted: 02/06/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To report a case of bilateral scleral compromise in a male patient with hereditary porphyria cutanea tarda (PCT). Methods Case report. Results A 57-year-old male was referred to the Cornea Service at Hospital de Clinicas in Buenos Aires for bilateral scleral thinning. He claimed ocular discomfort and photophobia. Slit-lamp biomicroscopy revealed an oval area of deep scleral thinning without uveal prolapse, adjacent to a conjunctival hyperemic zone in the interpalpebral area, 2 mm temporal to the limbus in the right eye. The left eye presented with a conjunctivalized scleral thinning in the interpalpebral area, 2 mm temporal to the limbus. Physical examination revealed facial hyperpigmentation and hypertrichosis and multiple hypopigmented scars in hands and nails. His family history was positive for PCT. The diagnosis was made by urine porphyrin test and genetic molecular testing. In an attempt to reduce ocular and systemic levels of porphyrins, the patient was treated with oral hydroxychloroquine and repeated phlebotomies, altogether with specially designed glasses to avoid local exposure to sunlight. Conclusions Scleral involvement is a rare manifestation of PCT. An adequate treatment, including interdisciplinary management may ameliorate ocular signs and symptoms.
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Affiliation(s)
- Eugenia Andrea Paez Soria
- Department of Ophthalmology, Hospital de Clínicas "José de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Federico Andres Cremona
- Department of Ophthalmology, Hospital de Clínicas "José de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Lucero Saá
- Department of Ophthalmology, Hospital de Clínicas "José de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Chiaradía
- Department of Ophthalmology, Hospital de Clínicas "José de San Martin", University of Buenos Aires, Buenos Aires, Argentina
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Pagnotta PA, Melito VA, Lavandera JV, Parera VE, Rossetti MV, Zuccoli JR, Buzaleh AM. Role of ABCB1 and glutathione S-transferase gene variants in the association of porphyria cutanea tarda and human immunodeficiency virus infection. Biomed Rep 2020; 14:22. [PMID: 33335728 PMCID: PMC7739863 DOI: 10.3892/br.2020.1398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022] Open
Abstract
In Argentina, porphyria cutanea tarda (PCT) is strongly associated with infection with human immunodeficiency virus (HIV); however, whether the onset of this disease is associated with HIV infection and/or the antiretroviral therapy has not been determined. The ABCB1 gene variants c.1236C>T, c.2677G>T/A and c.3435C>T affect drug efflux. The GSTT1 null, GSTM1 null and GSTP1 (c.313A>G) gene variants alter Glutathione S-transferase (GST) activity, modifying the levels of xenobiotics. The aim of the present study was to evaluate the role of genetic variants in initiation of PCT and to analyze the genetic basis of the PCT-HIV association. Control individuals, and HIV, PCT and PCT-HIV patients were recruited, PCR-restriction fragment length polymorphism was used to genotype the ABCB1 and GSTP1 variants, and multiplex PCR was used to study the GSTM1 and GSTT1 variants. The high frequency of c.3435C>T (PCT and PCT-HIV) and c.1236C>T (PCT) suggested that the onset of PCT were not specifically related to HIV infection or antiretroviral therapy for these variants. c.2677G>T/A frequencies in the PCT-HIV patients were higher compared with the other groups, suggesting that a mechanism involving antiretroviral therapy served a role in this association. PCT-HIV patients also had a high frequency of GSTT1 null and low frequency for GSTM1 null variants; thus, the genetic basis for PCT onset may involve a combination between the absence of GSTT1 and the presence of GSTM1. In conclusion, genes encoding for proteins involved in the flow and metabolism of xenobiotics may influence the PCT-HIV association. The present study is the first to investigate the possible role of GST and ABCB1 gene variants in the triggering of PCT in HIV-infected individuals, to the best of our knowledge, and may provide novel insights into the molecular basis of the association between PCT and HIV.
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Affiliation(s)
- Priscila Ayelén Pagnotta
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
| | - Viviana Alicia Melito
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
| | - Jimena Verónica Lavandera
- Cátedra de Bromatología y Nutrición, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe 3000, Argentina
| | - Victoria Estela Parera
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - María Victoria Rossetti
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - Johanna Romina Zuccoli
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - Ana Maria Buzaleh
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
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Calado JDOA, Bastos LMH, Miot HA. Case for diagnosis. Sclerodermiform manifestations of porphyria cutanea tarda secondary to hepatitis C. An Bras Dermatol 2019; 94:479-481. [PMID: 31644627 PMCID: PMC7007016 DOI: 10.1590/abd1806-4841.20198681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/06/2018] [Indexed: 11/21/2022] Open
Abstract
A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.
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Affiliation(s)
| | - Luan Moura Hortencio Bastos
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Bernardes Filho F, de Oliveira Alves A. Elderly Man With Bullous Eruption on the Feet. Ann Emerg Med 2017; 70:598-604. [PMID: 28946983 DOI: 10.1016/j.annemergmed.2017.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Fred Bernardes Filho
- Emergency Department, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, and the Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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