Nonsteroidal Antiinflammatory Drug-Induced Pseudoporphyria: A Case Series

Abstract

Pseudoporphyria is a relatively rarely reported condition. Clinical suspicion with appropriate laboratory and histopathologic findings help to make this diagnosis, and exclude true porphyrias. Rechallenge with the offending drug to produce symptom relapse has been proposed to be helpful in confirming this diagnosis of exclusion. Since all 6 patients with drug-induced pseudoporphyria experienced resolution of their symptoms after discontinuing the offending agent, we propose that this clinical correlation alone is sufficient to confirm this diagnosis. Our observation of six new cases of NSAID-induced pseudoporphyria over a two-year interval suggests that this is not a rare entity.

Pseudoporphyria as a result of voriconazole use: a case report

“…Pseudoporphyria, a dermatologic condition that imitates the clinical and histologic findings of porphyria cutanea tarda (PCT) without the laboratory findings, has been associated with various medications including NSAIDs (non‐steroidal anti‐inflammatory drugs), diuretics, tetracycline, estrogen, retinoids, cyclosporinee, flutamide, amiodarone, carisoprodol/aspirin therapy, pyridoxine and 5‐fluorouracil 10,12–25 . In addition, it has been associated with hemodialysis, Ripped Fuel™ (Twin Lab, Hauppauge, NY, USA) (ephedrine, caffeine, l ‐carnitine and chromium), excessive cola consumption and UVA radiation from tanning beds 13,14,26–28 .…”

“…This was the patient's first sun exposure since starting voriconazole and he had no previous history of photosensitivity despite significant sun exposure. Although pseudoporphyria has been reported with NSAID use, the patient was taking ibuprofen as necessary and had not taken any for several weeks 10,12–14 . Photosensitivity, Stevens–Johnson syndrome, toxic epidermal necrolysis, chelitis and discoid lupus erythematosus are dermatologic side‐effects of voriconazole that have been reported in the literature 1–9 .…”

“…The reported side‐effects of voriconazole include visual changes, headaches, elevated hepatic enzymes, Steven–Johnson syndrome, toxic epidermal necrolysis, chelitis, photosensitivity, discoid lupus erythematosus and anaphylactoid infusion reactions 1–9 . Pseudoporphyria was first described in association with nalidixic acid 10,11 . It has the same clinical and histologic features as porphyria cutanea tarda (PCT) but is distinguished by normal porphyrin levels in the serum, urine and stool.…”

The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs

“…While dermatologic reactions associated with piroxicam include vesiculobullous, eczematous, and lichenoid eruptions [ 183 – 185 ], naproxen most often induces pseudoporphyria, with additional reports of typical phototoxic reactions, although erythema multiforme-like and lichenoid reactions have also been described [ 28 , 32 , 94 , 126 , 127 ]. The manifestations can be diverse.…”

Drug-Induced Pseudoporphyria: A Case Report

“…Singlet oxygen is produced by naproxen and other NSAIDs when they come into contact with UVA rays. This singlet oxygen could then cause phototoxicity [5]. Dialysis may hasten the development of pseudoporphyria in genetically susceptible patients by inducing oxidative stress or by signaling a more advanced degree of renal failure [6].…”