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Erythropoietic Coproporphyria
Coproporphyria Erythropoietic

Presentation

Presents outstanding photographs for virtually every common skin disorder. [books.google.de]

Four of the patients were adolescents presenting with abdominal pain and neuropathy, similar to the symptoms seen in AIP. There was one infant with more severe symptoms presenting with failure to thrive early after birth. [clinicaladvisor.com]

Patients with HCP and VP can present with symptoms shared between the acute and cutaneous porphyrias. [en.wikipedia.org]

Diabetes mellitus is present in 15-20% of PCT patients. [stmina-monastery.org]

(b) The sticky patch is present on the oxygenated Hbs (R form) and deoxygenated Hbs (T form) but never present on oxy-HbA (R form). [biologydiscussion.com]

Hematological

  • Hemophilia A

    In the early 1950s patients with porphyrias (occasionally referred to as "Porphyric Hemophilia") and severe symptoms of depression or catatonia were treated with electroshock therapy. [house.wikia.com]

    In the early 1950s, patients with porphyrias (occasionally referred to as "porphyric hemophilia"[55]) and severe symptoms of depression or catatonia were treated with electroshock therapy. [en.wikipedia.org]

Entire Body System

  • Asymptomatic

    The condition is usually asymptomatic, but acute attacks resembling those of acute intermittent porphyria can occur. cop·ro·por·phyr·i·a ( kop'rō-pōr-fir'ē-ă ), [MIM*121300] Presence of coproporphyrins in the urine, as in variegate porphyria. coproporphyria [medical-dictionary.thefreedictionary.com]

    HCP was first described by Berger and Goldberg in 1955 and was considered an asymptomatic biochemical abnormality. [ncbi.nlm.nih.gov]

    Identification of asymptomatic patients allows them to adjust their lifestyle to avoid common triggering factors. [2] [7] References [ edit ] ^ a b c d e f "#121300 COPROPORPHYRIA, HEREDITARY; HCP". Johns Hopkins University. [en.wikipedia.org]

    For asymptomatic individuals, the urine studies may be normal, but a fecal porphyrin analysis will show elevation of coproporphyrin III. Screening tests of this kind should be confirmed by DNA analysis to confirm a CPOX mutation. [porphyriafoundation.blogspot.com]

  • Pediatric Disease

    In Biochemical and Molecular Basis of Pediatric Disease. Fourth edition. Edited by DJ Dietzen, MJ Bennett, ECC Wong. AACC Press, 2010, pp 307-324 2. Nuttall KL, Klee GG: Analytes of hemoglobin metabolism - porphyrins, iron, and bilirubin. [mayomedicallaboratories.com]

    Biochemical and Molecular Basis of Pediatric Disease (4th ed.). Washington, DC: AACC Press. pp. 307–324. ISBN 978-1-59425-100-9. ^ a b c d e f g h Lourenco, Charles Marquez; Lee, Chul; Anderson, Karl E. (2012). "Disorders of Haem Biosynthesis". [en.wikipedia.org]

Gastrointestinal

  • Abdominal Pain

    Such episodes are often provoked by barbiturates, sulphonamides and other drugs, and include automatic symptoms (hypertension, tachycardia, abdominal pain, constipation), central (epileptic seizures, mental disturbances) and peripheral nervous system [ncbi.nlm.nih.gov]

    Evaluation of the patient with abdominal pain and suspected porphyria Porphyria should suspected in the pediatric population, particularly in adolescents who present with abdominal pain and no obvious clinical explanation. [clinicaladvisor.com]

    She was suffering from extreme abdominal pain, gallstones and a rash that resembled necrotizing fasciitis. [house.wikia.com]

    For example, painkillers can be prescribed for abdominal pain and medication can be used to combat nausea and vomiting. [patient.info]

    The second most common form, acute intermittent porphyria (AIP), is characterized by life-threatening attacks of severe abdominal pain, constipation, tachycardia, and neuropsychiatric abnormalities. [amboss.com]

  • Constipation

    Such episodes are often provoked by barbiturates, sulphonamides and other drugs, and include automatic symptoms (hypertension, tachycardia, abdominal pain, constipation), central (epileptic seizures, mental disturbances) and peripheral nervous system [ncbi.nlm.nih.gov]

    Symptoms include pain in the chest, abdomen, limbs, or back; muscle numbness, tingling, paralysis, or cramping; vomiting; constipation; and personality changes or mental disorders. These symptoms come and go. [icdlist.com]

    […] when exposed to sunlight § redness § blistering § infections § scarring § changes in pigmentation § increased hair growth Symptoms of acute porphyrias ( include acute intermittent porphyria, ALAD deficiency porphyria ) - abdominal pain - vomiting - constipation [hjk880524.tripod.com]

    Symptoms are pain in gut, limbs, or torso; paralysis, vomiting, constipation, personality changes, paranoia. These symptoms can last for hours, days, or weeks. [myporphyria.com]

    The most serious symptoms are caused by acute porphyria which can include anxiety, stomach pain, diarrhea, fever, liver issues, trouble breathing, personality changes, seizures, paralysis, hallucinations and constipation. [disabilitybenefitshome.com]

  • Vomiting

    Symptoms include pain in the chest, abdomen, limbs, or back; muscle numbness, tingling, paralysis, or cramping; vomiting; constipation; and personality changes or mental disorders. These symptoms come and go. [icdlist.com]

    […] sensitive skin when exposed to sunlight § redness § blistering § infections § scarring § changes in pigmentation § increased hair growth Symptoms of acute porphyrias ( include acute intermittent porphyria, ALAD deficiency porphyria ) - abdominal pain - vomiting [hjk880524.tripod.com]

    You'll get medicine for pain, nausea, and vomiting. You may also need to get a type of sugar called glucose, which you might take by mouth or get put into your veins through an IV. Your doctor may also give you an injection of hemin (Panhematin). [webmd.com]

    MB The most important step is to stabilize patients, and address symptoms such as nausea, vomiting, hypertension, and electrolyte imbalances such as hyponatremia. [hematologyandoncology.net]

    Symptoms are pain in gut, limbs, or torso; paralysis, vomiting, constipation, personality changes, paranoia. These symptoms can last for hours, days, or weeks. [myporphyria.com]

  • Nausea

    MB The most important step is to stabilize patients, and address symptoms such as nausea, vomiting, hypertension, and electrolyte imbalances such as hyponatremia. [hematologyandoncology.net]

    Medications for pain, nausea, and vomiting and close observation are generally required. During treatment of an attack, attention should be given to sodium (salt) and water balance. Harmful drugs should be stopped. [porphyriafoundation.blogspot.com]

    Stress (e.g., surgery, infection) Pathophysiology : defective PBG-D → accumulation of porphobilinogen ( PBG ) and δ-aminolevulinic acid ( ALA ) → symptoms Clinical features Fever GI symptoms : severe abdominal pain, nausea, vomiting Neurological abnormalities [amboss.com]

    For example, painkillers can be prescribed for abdominal pain and medication can be used to combat nausea and vomiting. [patient.info]

    Nausea can be severe; it may respond to phenothiazine drugs but is sometimes intractable. Hot water baths or showers may lessen nausea temporarily, but can present a risk of burns or falls. [house.wikia.com]

  • Blood in Stool

    This may involve further testing of your urine and sometimes your stools (faeces) and blood. Note that between attacks, the porphyrin levels in your urine may be normal. [patient.info]

    Also porphyrins in the blood and stool should be measured. The level of PBG in the body can vary so the best time to take samples is during an acute attack (e.g. when someone is having abdominal pain, etc). [rarediseasesnetwork.org]

Liver, Gall & Pancreas

  • Jaundice

    Sickle cells are more fragile and causes hemolytic anemia and jaundice. ii. Packing of these abnormal red cells into vessels, specially capillaries of organs cause vascular stasis and anoxic damage to the tissue. Relation with other Diseases : i. [biologydiscussion.com]

    If these measures are ineffective (eg, patients have increasing photosensitivity, rising porphyrin levels, progressive jaundice), giving hematin and/or RBC hypertransfusion (ie, to above-normal Hb levels) may reduce protoporphyrin overproduction. [merckmanuals.com]

    […] disease-causing mutation will express symptoms. [2] Individuals who are homozygous for a specific mutation (K404E) or compound heterozygous with a null allele in CPOX have a more severe erythropoietic porphyria, harderoporphyria, [5] characterized by neonatal jaundice [en.wikipedia.org]

    Fatigue and muscle weakness are symptoms and sometimes the patient may be jaundiced. There are marked increases in the excretion of coproporphyrins in the urine and feces and there are usually increased excretions of PBG and ALA in the urine. [albertaporphyriasociety.weebly.com]

    Not all porphyrias are genetic, and patients with liver disease who develop porphyria as a result of liver dysfunction may exhibit other signs of their condition, such as jaundice. [house.wikia.com]

Skin

  • Skin Disease

    A wealth of new features makes it easier, than any other resource, to identify, treat, and manage the full range of skin diseases. Presents outstanding photographs for virtually every common skin disorder. [books.google.de]

    In coproporphyria, skin disease also is present but not as commonly as the neurovisceral symptoms. The etiology of the skin disease may be the deposition of formed porphyrins in the skin that react with sunlight and lead to skin damage. [emedicine.medscape.com]

    Typically, the effects are not visible, though occasionally there may be some redness and swelling of the skin. Vesiculo-erosive skin disease. [en.wikipedia.org]

    You might see: Hematologists, doctors who treat blood diseases Dermatologists, specialists in skin diseases Hepatologists, doctors who treat liver diseases Genetic counselors, who advise people about their risk for inherited diseases It may take time [webmd.com]

    It is a skin disease only and is caused by decreased activity of the final enzyme step in the heme biosynthetic pathway, called uroporphyrinogen decarboxylase (URO. D). [albertaporphyriasociety.weebly.com]

Psychiatrical

  • Psychiatric Manifestation

    It results in neurologic damage and can include abdominal pain, constipation and psychiatric manifestations. [icd10data.com]

    The predominant problem is neurologic damage that leads to peripheral and autonomic neuropathies and the psychiatric manifestations. In coproporphyria, skin disease also is present but not as commonly as the neurovisceral symptoms. [emedicine.medscape.com]

  • Delusion

    Other psychiatric symptoms such as anxiety, restlessness, insomnia, depression, mania, hallucinations, delusions, confusion, catatonia, and psychosis may occur.[43] Underlying liver disease[edit] Some liver diseases may cause porphyria even in the absence [en.wikipedia.org]

Neurologic

  • Neurologic Manifestation

    In the few reported cases, clinical manifestations were primarily neurologic, without cutaneous photosensitivity. [ommbid.mhmedical.com]

    (b) Porphyria variegata: (i) Increased excretion of porphobilinogen in the urine during acute neurological manifestations and turns to normal in remission. (ii) Elevated urinary copro-and uroporphyrins and also fecal protoporphyrin. [biologydiscussion.com]

    ALADP is the rarest type of porphyria and is an autosomal recessive disorder. 10, 11 PCT is a porphyria that causes chronic blistering skin photo toxicity but has no neurological manifestation and is the most common type or form (estimated incidence of [medcraveonline.com]

    A review of the pathogenesis of the neurological manifestations of the acute porphyrias. Seminars in Liver Disease 1998;18:43-52. [10] Kauppinen R, Mustajoki P. [the-medical-dictionary.com]

    Seizures could be a neurologic manifestation of the disease but could also be secondary to hyponatremia. Long-term risks for hypertension, impaired renal function. and hepatocellular carcinoma are increased. [clinicaladvisor.com]

  • Personality Change

    Symptoms are pain in gut, limbs, or torso; paralysis, vomiting, constipation, personality changes, paranoia. These symptoms can last for hours, days, or weeks. [myporphyria.com]

    The most serious symptoms are caused by acute porphyria which can include anxiety, stomach pain, diarrhea, fever, liver issues, trouble breathing, personality changes, seizures, paralysis, hallucinations and constipation. [disabilitybenefitshome.com]

    During an episode, a person may also experience muscle weakness, seizures, fever, and mental changes such as anxiety and hallucinations. [icdlist.com]

    Symptoms of acute porphyria include pain in the chest, abdomen, limbs, or back; muscle numbness, tingling, paralysis, or cramping; vomiting; constipation; and personality changes or mental disorders. These symptoms appear intermittently. [genome.gov]

  • Guillain-Barré Syndrome

    For instance, the polyneuropathy of acute porphyria may be mistaken for Guillain–Barré syndrome, and porphyria testing is commonly recommended in those situations.[6] Elevation of aminolevulinic acid from lead-induced disruption of heme synthesis results [en.wikipedia.org]

Urogenital

  • Red Urine

    Main Outcomes Measures Measurement of protoporphyrin concentration in red blood cells and feces by fluorometry and chromatography. Analysis of the mutations of the FECH gene by single-strand conformation analysis. [thedoctorsdoctor.com]

    Some signs and symptoms of an acute attack are: pain, red, burning or blistering skin, red urine, neurological changes, or psychological changes. Resources BOOKS Deats-O'Reilly, Diana. Porphyria: The Unknown Disease. [healthofchildren.com]

    Patients present with hemolysis leading to splenomegaly, also due to increased deposition in the red blood cells. Diagnosis: Uroporphyrin I and coproporphyrin I accumulate in the bone marrow, red blood cells, plasma, urine, and feces. [clinicaladvisor.com]

    In some forms of porphyria, accumulated heme precursors excreted in the urine may cause various changes in color, after exposure to sunlight, to a dark reddish or dark brown color. Even a purple hue or red urine may be seen. [house.wikia.com]

    Clinical findings Non-immune hydrops fetalis Signs of congenital erythropoietic porphyria Pink to dark red discoloration of the urine (pink or dark red urine-stained diapers are often the first sign in infants) Hemolytic anemia Severe cutaneous photosensitivity [ncbi.nlm.nih.gov]

  • Dark Urine

    Uroporphyrin I; to dark brown staining of the nappies; Urine will fluoresce reddish-pink under Wood's light Coproporphyrin I Uroporphyrin I; Stable fluorescence Erythropoietic Protoporphyria (EPP) Erythropoietic; Autosomal dominant; Childhood Symptoms [stmina-monastery.org]

    In some forms of porphyria, accumulated heme precursors excreted in the urine may cause various changes in color, after exposure to sunlight, to a dark reddish or dark brown color. Even a purple hue or red urine may be seen. [house.wikia.com]

Workup

The workup of patients with a suspected porphyria is most effective when following a stepwise approach. [mayomedicallaboratories.com]

Biopsy

  • Liver Biopsy

    Laparoscopic finding of our case showed a map-like appearance of the liver surface with slightly depressed dark-bluish areas and reddish-brown areas. The liver biopsy specimen showed red fluorescence under ultraviolet light. [ncbi.nlm.nih.gov]

    Liver function and RBC and plasma protoporphyrin levels should be checked annually. Patients with abnormal liver function test results should be evaluated by a hepatologist; a liver biopsy may be needed to stage the degree of fibrosis. [merckmanuals.com]

    Liver biopsy may demonstrate mild portal lymphocytic infiltration or micronodular cirrhosis. Red fluorescence of the teeth under Wood's light. [stmina-monastery.org]

    Liver biopsy usually shows fatty infiltration and inflammatory changes, with cirrhosis being present in a third of cases.[30] Porphyria cutanea tarda increases the risk of hepatocellular carcinoma in patients with chronic liver disease.[30-32] Treatment [the-medical-dictionary.com]

Treatment

الصفحة 295 - Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). ‏ [books.google.com]

Many chapters have been completely revised to reflect the latest treatment recommendations, procedures and therapeutic guidelines. [books.google.de]

What are treatments for Hereditary Coproporphyria? Treatment, complications, and preventive measures are the same as in AIP. Hospitalization is often necessary for acute attacks. [porphyriafoundation.blogspot.com]

If you are able to confirm that the patient has a porphyria, what treatment should be initiated? The treatment will always depend on the type of porphyria (see above for specific treatments in each different type of the disease). [clinicaladvisor.com]

If the above treatments are contraindicated, iron-chelating compounds may be used. Treatment of PCT probably reduces the risk for developing HCC. [medicaljournals.se]

Prognosis

What is the Prognosis of Hereditary Coproporphyria? (Outcomes/Resolutions) The prognosis of Hereditary Coproporphyria varies with the severity of the condition. [dovemed.com]

The prognosis is usually good if the disease is recognized and treated promptly, before nerve damage develops. [porphyriafoundation.blogspot.com]

Diagnosis - Congenital erythropoietic prophyria Prognosis - Congenital erythropoietic prophyria Not supplied. [checkorphan.org]

H&O What is the prognosis for someone with acute porphyria? MB The overall prognosis is good because specific treatment is available, but symptoms must be recognized and managed correctly. [hematologyandoncology.net]

Etiology

Phlebotomy Hydroxychloroquine or chloroquine References: [1] [2] [3] Acute intermittent porphyria (AIP) Epidemiology Second most common porphyria Peak incidence : ∼ 30 years Sex: ♀ > ♂ (2:1) Especially common in Great Britain and Scandinavian countries Etiology [amboss.com]

For porphyria etiology and pathophysiology, see Overview of Porphyrias. Erythropoietic protoporphyria, which comprises about 90% of EPP phenotypic presentations results from inherited deficiency of the enzyme ferrochelatase (FECH). [merckmanuals.com]

The etiology of the skin disease may be the deposition of formed porphyrins in the skin that react with sunlight and lead to skin damage. [emedicine.medscape.com]

(Etiology) Hereditary Coproporphyria is caused by mutations in the CPOX gene on chromosome 9, which is involved in the production of “heme”. Heme is a critical component of iron-containing proteins called hemoproteins. [dovemed.com]

Late-onset X-linked dominant protoporphyria: an etiology of photosensitivity in the elderly. J Invest Dermatol. 2013;133:1688-1690. 14. Wang Y, Langer NB, Shaw GC, et al. [hematology.org]

Epidemiology

The 5 P's: Painful abdomen, Polyneuropathy, Psychologic disturbances, Purple pee, Precipitated by triggers like drugs Erythropoietic porphyrias Congenital erythropoietic porphyria (Gunther disease) Epidemiology Very rare Severe Genetics Autosomal recessive [amboss.com]

Patients with Porphyria in Brazil have the same epidemiological characteristic as the US and UK. In Brazil, porphyria should be studied more carefully in order to assess, properly diagnose and treat. [medcraveonline.com]

Puy H, Deybach J‐C, Lamoril J et al. (1997) Molecular epidemiology and diagnosis of PBG deaminase gene defects in acute intermittent porphyria. American Journal of Human Genetics 60: 1373–1383. Puy H, Gouya L and Deybach J‐C (2010) Porphyrias. [els.net]

[…] neurovisceral attacks always have elevations of porphobilinogen and ALA, researchers still are unclear about how this leads to the symptomatic disease because most patients with the genetic defect have excessive porphyrin secretion but no symptoms. [1] Epidemiology [emedicine.medscape.com]

Molecular epidemiology of erythropoietic protoporphyria in the U.K. Br J Dermatol. 2010;162(3):642–646. 11. Goodwin RG, Kell WJ, Laidler P, et al. [dovepress.com]

Pathophysiology

Stress (e.g., surgery, infection) Pathophysiology : defective PBG-D → accumulation of porphobilinogen ( PBG ) and δ-aminolevulinic acid ( ALA ) → symptoms Clinical features Fever GI symptoms : severe abdominal pain, nausea, vomiting Neurological abnormalities [amboss.com]

The following algorithms are available in Special Instructions: -Porphyria (Acute) Testing Algorithm -Porphyria (Cutaneous) Testing Algorithm Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a [mayomedicallaboratories.com]

For porphyria etiology and pathophysiology, see Overview of Porphyrias. Erythropoietic protoporphyria, which comprises about 90% of EPP phenotypic presentations results from inherited deficiency of the enzyme ferrochelatase (FECH). [merckmanuals.com]

Pathophysiology Coproporphyria is an autosomal dominant disease that results from defects in the enzyme coproporphyrinogen oxidase. This enzyme speeds the conversion of coproporphyrinogen to protoporphyrinogen. [emedicine.medscape.com]

Pathophysiology: The disease is often activated by different environmental or hormonal factors such as drugs, diet, and steroid hormones in individuals with the genetic predisposition. [clinicaladvisor.com]

Prevention

Very frequent premenstrual attacks can be prevented by a gonadotropin-releasing hormone (GnRH) analogue administered with expert guidance. In selected cases, frequent noncyclic attacks can be prevented by once- or twice-weekly infusions of hemin. [porphyriafoundation.blogspot.com]

Acute Intermittent Porphyria – If acute attacks are successfully prevented life expectancy is normal. Early effective treatment of the acute attcks that do occur usually prevents permanent nerve damage. [myvmc.com]

Prevent symptoms by avoiding sun exposure and sometimes using drugs (eg, beta-carotene, cysteine). Hematin and/or RBC hypertransfusion may reduce protoporphyrin overproduction. [merckmanuals.com]

Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.de]

Avoiding your triggers will help prevent bouts of symptoms. Remember that everyone with porphyria is different. Some people have milder symptoms than others. Treatments can help you feel better and prevent complications. [webmd.com]

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