Purpuric Phototherapy-induced Eruption in Transfused Neonates: Relation to Transient Porphyrinemia

Abstract

The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

Phototherapy induced cutaneous eruption in a neonate with transient porphyrinemia

“…Transient porphyrinemia may be supported by obtaining total porphyrins and monitoring their decline over time. The majority of reported patients showed improvement in their porphyrin levels by 5 months of age [1][2][3].…”

“…Transient porphyrinemia has been associated with a photosensitive cutaneous eruption in neonates with erythroblastosis fetalis who received exchange transfusions and were exposed to phototherapy [1][2][3][4][5].…”

Causes, Management and Immediate Complications of Management of Neonatal Jaundice ? A Hospital-Based Study

“…Over one-quarter of the patients exhibited rash which is considered much higher compared to other studies. 18,19 Neonatal jaundice is a leading cause of hospitalisation in the first few weeks of life throughout the world. Pathological jaundice is associated with significant morbidity and mortality.…”

Cutaneous porphyria in a neonate with tyrosinaemia type 1

“…Interactions between photoactivated conjugated bilirubin and copper-porphyrins lead to a bronze discolouration rather than to a purpura, with an excess of proto-, copro-and uroporphyrins [2,11]. Recently, porphyrinaemia due to cholestasis was proposed as one causative factor of`purpuric phototherapy-induced eruptions' and of`bullous eruptions' in three neonates described in two dierent reports [5,10]. All had conjugated hyperbilirubinaemia (peak total bilirubin ranging from 22.2 to 26.4 mg/dl, with a conjugated fraction of 9.8 to 14.6 mg/dl) associated with erythroblastosis fetalis due to Rhesus iso-immunisation, which is also the most frequent condition associated with the bronze baby syndrome.…”