Porphyria cutanea tarda, the most common form of porphyria in the world, is caused by decreased activity of the enzyme uroporphyrinogen decarboxylase. This enzyme defect either can occur sporadically ...or can be inherited in an autosomal dominant manner. It is characterized by skin hyperpigmentation, vesicles, hypertrichosis, and easy bruisability. Most patients with the disorder have evidence of chronic liver disease, ranging from steatosis to chronic active hepatitis to cirrhosis. The cause of these liver abnormalities is unknown, but previously had been attributed to the effects of alcohol, iron overload, or both. New data have recently shown that the presence of hepatitis C virus (HCV) is the single most common hepatic abnormality in patients with porphyria cutanea tarda. It has been proposed that HCV may play a critical role in the pathogenesis of liver disease associated with porphyria cutanea tarda. We report an interesting case of a patient with HCV and acute hepatocellular necrosis in association with newly symptomatic porphyria cutanea tarda.
