Rifampicin
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Porphyria cutanea tarda: case report A 59-year-old man was admitted after developing porphyria cutanea tarda while receiving rifampicin for the treatment of pulmonary tuberculosis. The man, who also had a history of injection drug use, alcohol abuse and chronic hepatitis C infection, started receiving rifampicin 600mg [frequency and route not stated] as well as isoniazid, ethambutol and pyrazinamide. Three days after starting this treatment, he developed a progressive blistering eruption over his neck, lateral arms and forearms. He stopped all the drugs 2 weeks later because of a suspected drug eruption. A biopsy of a blister on his forearm showed subepidermal bullae. Further investigations revealed elevated urine and faecal porphyrins, as well as an elevated serum ferritin level (1481 pmol/L). Overall, the findings were consistent with a diagnosis of porphyria cutanea tarda. The man underwent venesection to have five units of blood removed. His serum iron and haemoglobin levels dropped, and his urine porphyrin levels normalised. After 2 months, he gradually started treatment with levofloxacin and ethambutol. His skin condition improved, with no further blister formation on follow-up. Author comment: "Of the antituberculosis drugs that our patient was taking, only rifampicin has been reported to induce porphyria cutanea tarda." Lee CH, et al. A man with a blistering eruption and tuberculosis. BMJ 344: [3 pages], No. 8351, 6 Jan 2012. Available from: URL: http://dx.doi.org/10.1136/ 803069736 bmj.d8351 - Hong Kong
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Reactions 5 May 2012 No. 1400
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