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Blood, 1 January 2006, Vol. 107, No. 1, pp. 60-62.
Prepublished online as a Blood First Edition Paper on September 8, 2005; DOI 10.1182/blood-2004-12-4939.


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CLINICAL TRIALS AND OBSERVATIONS
Brief report

Photosensitivity and acute liver injury in myeloproliferative disorder secondary to late-onset protoporphyria caused by deletion of a ferrochelatase gene in hematopoietic cells

Richard G. Goodwin, W. Jonathan Kell, Peter Laidler, C. Colin Long, Sharon D. Whatley, Mark McKinley, Michael N. Badminton, Alan K. Burnett, Geraint T. Williams, and George H. Elder

From the Departments of Dermatology, Haematology, Pathology, Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, and School of Medicine, Cardiff University, Cardiff, United Kingdom.

Late-onset erythropoietic protoporphyria (EPP) is a rare complication of myelodysplastic syndrome (MDS) but has not been described in association with a myeloproliferative disorder (MPD). EPP is normally an inherited disorder characterized by photosensitivity that starts in early childhood and results from overproduction of protoporphyrin secondary to ferrochelatase (FECH) deficiency. Severe liver disease occurs in 1% to 2% of patients. Here we report that severe photosensitivity and cholestatic liver disease in a patient with a myeloproliferative disorder was caused by excess protoporphyrin production from a clone of hematopoietic cells in which one FECH allele had been deleted. Our observations suggest that the usual explanation for the association of late-onset EPP with MPD and MDS is acquired somatic mutation of one FECH allele in bone marrow and show for the first time that the consequent overproduction of protoporphyrin may be severe enough to cause acute liver damage.


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