Purpuric Eruption in a Transfused Neonate Receiving Phototherapy

Abstract

We describe the clinical and biochemical findings in a neonate requiring multiple blood transfusions and phototherapy for alloimmune hemolytic anemia and unconjugated hyperbilirubinemia, respectively. In this newborn, a severe photosensitivity reaction developed and laboratory testing revealed elevated serum and urine porphyrins at the time of the eruption. The cause of the transient porphyrinemia was likely multifactorial. Possible mechanisms include poor hepatic metabolism and reticulocyte hemolysis. However, the exact pathogenesis remains unclear at this time.

Phototherapy‐induced blistering reaction and eruptive melanocytic nevi in a child with transient neonatal porphyrinemia

“…or resulted in localized atrophy, scarring or milia. [2][3][4][5][6] We found no clue to the etiology of transient porphyrinemia in the present patient. The acute phototoxic reaction was similar to those reported previously, but the eruption of melanocytic nevi 3 months after the blistering reaction is unique.…”

“…Preterm infants have highly variable iron status, but infants born at term usually have sufficient iron stores until 4‐6 months of age. Abnormal liver or renal functions may interfere with the porphyrin metabolism and excretion, and high transaminase levels, cholestasis, and mild renal dysfunction have been observed in some affected newborns, but this does not explain the high erythrocyte porphyrin levels previously reported and seen in the present newborn. Drugs and heavy metals may likewise act as possible causal agents, but their role did not emerge in any of the cases.…”

“…Transient porphyrinemia in newborns seems to be rare, the present being the tenth case reported . All cases were detected because of adverse reactions to phototherapy.…”

“…Porphyrin levels had returned to normal by the age of 4 to 5 months in all of the infants reported. The acute cutaneous symptoms resolved spontaneously without any permanent sequelae, or resulted in localized atrophy, scarring or milia …”

Transient Porphyrinemia in a Neonate: A Case Report

“…High porphyrin levels are toxic to tissues, and manifestations can be cutaneous, neurologic, or both . Transient porphyrinemia is a rare dermatosis that manifests as a photodistributed erythematous, violaceous, or purpuric‐appearing eruption 1 to 5 days after exposure to phototherapy . These eruptions improve with cessation of phototherapy and resolve within 2 to 7 days .…”