A 53-year-old woman with end-stage renal disease started hemodialysis (HD) because of diabetic nephropathy that had begun 3 years before. Over the course of 2 months, she intermittently presented blisters on both dorsal hands and forearms (Figure 1), which were exacerbated by sun exposure. In addition, her bilateral malar area showed hyperpigmentation and hypertrichosis (Figure 2). A skin biopsy taken from her left forearm revealed subepidermal bullae, festooning of rete ridges and hyalinization of blood vessel walls, all consistent with porphyria. Since the patient was anuric, we examined her plasma porphyrin level, discovering high totals of porphyrins (58.3 mcg/dl) and uropor-phyrin (41.7 mcg/dl), confirming the diagnosis of porphyria cutanea tarda (PCT). Laboratory analysis reported hemoglobin 9.5 g/dl, ferritin 344.2 ng/ml and negative serology for hepatitis C.
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