[Porphyria cutanea tarda revealed by voriconazole].
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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Hickman
G
G
Service de dermatologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Duval
A
A
Picard
C
C
Petit
A
A
D000368:Aged; D000437:Alcoholism / Q000150:complications; D000935:Antifungal Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002613:Cheilitis / Q000139:chemically induced; D005243:Feces / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000201:enzymology; D008297:Male; D010787:Photosensitivity Disorders / Q000139:chemically induced*; D017119:Porphyria Cutanea Tarda / Q000150:complications / Q000175:diagnosis*; D011166:Porphyrins / Q000032:analysis / Q000097:blood / Q000652:urine; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000188:drug therapy; D011743:Pyrimidines / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D014575:Uroporphyrinogen Decarboxylase / Q000037:antagonists & inhibitors; D065819:Voriconazole
D000935:Antifungal Agents; D011166:Porphyrins; D011743:Pyrimidines; D014230:Triazoles; D014575:Uroporphyrinogen Decarboxylase; D065819:Voriconazole