A case of porphyria cutanea tarda with multiple hyperechoic lesions in the liver

A 49-year-old man was admitted to the hospital because of liver dysfunction and multiple hyperechoic lesions in the liver. He has the history of blood transfusion and diabetes mellitus, for which he takes Glibenclamide. For 30 years he had drunk one bottle of beer per day. There was no family history of skin disease. On admission, there was no pigmentation on the skin and no hepatosplenomegaly. On peritoneoscopic examination, multiple dark purple colorations were found on the uneven liver surface. On ultrasonic peritoneoscopy, those lesions were described as hyperechoic lesions. The aimed biopsy specimen of the dark purple lesion showed a weak red fluorescence under ultraviolet light. Histology of the liver biopsy showed chronic persistent hepatitis, and fatty degeneration was observed in the dark purple lesion. Since the examinations of porphyrins showed the increased contents of uroporphyrin and 7-carboxyl porphyrin in urine, the case was diagnosed as porphyria cutanea tarda. Ultrasonic peritoneoscopy and peritoneoscopic ultrasonogram guided biopsy were the important diagnostic procedures for this patient.