Trospium chloride overdose

Abstract

A 53-year old woman developed porphyria cutanea tarda (PCT) during treatment with tamoxifen.The woman presented with a 2-year history of purplish macules, bullae, erosions and scarring on the back of the hands. She also had hypertrichosis of the face, red discolouration of the urine and hyperpigmentation of sunexposed areas. Three years prior, she had undergone a radical mastectomy for a right breast carcinoma and had been subsequently maintained on tamoxifen 20 mg/day [route not stated]. Examination of a hand lesion revealed a subepidermal blister, acanthosis of the epidermis and an inflammatory infiltrate surrounding papillary dermis vasculature. Laboratory results showed elevated hepatic enzymes, markedly increased total porphyrin levels and coproporphyrins, and a moderate increase in uroporphyrins. Findings were consistent with PCT.The woman was advised to replace tamoxifen with letrozole and use sun protection. She received Intense Pulse Light for the hypertrichotic areas. By the third month following tamoxifen withdrawal, her urinary total porphyrin levels had decreased from 6554 µg/24h to 2845 µg/24h with normalisation by the sixth month. Her liver enzymes also returned to normal, and she had no recurrence of skin lesions. At follow-up, 2 years after remission, there were no signs of PCT. Author comment: "[T]he temporal relationship between the symptoms and tamoxifen in a patient medicated exclusively with this drug, the progressive fall of urine porphyrin levels following the interruption of the treatment and the absence of any other causative factor of PCT all support the diagnosis of PCT induced by tamoxifen." Cruz MJ, et al. Porphyria cutanea tarda induced by tamoxifen. Dermatology Online Journal 16: No.