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Acute Porphyria and Coproporphyrinuria Following Chloroquine Therapy: A Report of Two Cases

Acute Porphyria and Coproporphyrinuria Following Chloroquine Therapy: A Report of Two Cases Abstract The fact that acute intermittent porphyria can be precipitated by various chemicals is well recognized and amply reported in the literature.1-3 The chemicals most frequently described as initiating the clinical picture of acute intermittent porphyria are the barbiturates, sulfonmethane (Sulfonal), sulfonethylmethane (Trional), alcohol, and allylisopropylacetylcarbamide (Sedormid). Waldenström4 first demonstrated that the barbiturates are capable of precipitating acute attacks of porphyria in individuals having latent porphyria but who were previously free of symptoms. In September, 1954, Linden et al.5 reported the case of a patient who had an episode typical of acute intermittent porphyria shortly after receiving chloroquine. This patient was under treatment for six years for chronic discoid lupus erythematosus. Four days after the patient was started on chloroquine therapy, 0.5 gm. daily, he developed chills, low-grade fever, vomiting, and abdominal pain. His urine turned Burgundy red, and tests were positive for uroporphyrin References 1. Watson, C. J.: Porphyria, in Advances in Internal Medicine , edited by W. Dock and I. Snapper, Chicago, The Year Book Publishers, Inc., 1954, Vol. 6, pp. 235-299. 2. Schwartz, S.: Porphyrins and Porphyrin Precursors in Human and Experimental Porphyria , Federation Proc. 14:717-722, 1955. 3. Schmid, R., and Schwartz, S.: Experimental Porphyria: III. Hepatic Type Produced by Sedormid , Proc. Soc. Exper. Biol. & Med. 81:685, 1952. 4. Waldenström, J.: Studien über Porphyrie , Acta med. scandinav. , (Supp.) 82:1-254, 1937. 5. Linden, S. H.; Steffen, C. G.; Newcomer, V. D., and Chapman, M.: Development of Porphyria during Chloroquine Therapy for Chronic Discoid Lupus Erythematosus , California Med. 81:235-237, 1954. 6. Goodman, L. S., and Gilman, A. Z.: The Pharmacological Basis of Therapeutics , Ed. 2, New York, The MacMillan Company, 1955. 7. Berliner, R. W.; Earle, D. P., Jr.; Taggart, J. V.; Zubrod, C. G.; Welch, W. J.; Conan, N. J.; Bauman, E.; Scudder, S. T., and Shannon, J. A.: Studies on the Chemotherapy of the Human Malarias: VI. The Physiological Disposition, Antimalarial Activity, and Toxicity of Several Derivatives of 4-Aminoquinoline , J. Clin. Invest. 27(No. (3) , Pt. 2):98-107, 1948. 8. Titus, E. O.; Craig, L. C.; Golumbic, C.; Mighton, H. R.; Wempen, M., and Elderfield, R. C.: Identification by Distribution Studies: IX. Application to Metabolic Studies of 4-Aminoquinoline Antimalarials , J. Org. Chem. 13:39-62, 1948. 9. Jailer, J. W.; Rosenfeld, M., and Shannon, J. A.: The Influence of Orally Administered Alkali and Acid on the Renal Excretion of Quinacrine, Chloroquine and Santoquine , J. Clin. Invest. 26:1168-1172, 1947. 10. Alving, A. S.; Eichelberger, L.; Craige, B., Jr.; Jones, R., Jr.; Whorton, C. M., and Pullman, T. N.: Studies on the Chronic Toxicity of Chloroquine (SN-7618) , J. Clin. Invest. 27(No. (3) , Pt. 2):60-65, 1948. 11. Craige, B., Jr.; Whorton, C. M.; Jones, R., Jr.; Pullman, T. N.; Alving, A. S.; Eichelberger, L., and Rothman, S.: A Lichen-Planus-like Eruption Occurring During the Course of Chloroquine Administration , J. Clin. Invest. 27(No. (3) , Pt. 2):56-59, 1948. 12. Pillsbury, D. M., and Jacobson, C.: Treatment of Chronic Discoid Lupus Erythematosus with Chloroquine (Aralen) , J. A. M. A. 154:1330-1333, 1954. 13. Rogers, J., and Finn, O. A.: Synthetic Antimalarial Drugs in Chronic Discoid Lupus Erythematosus and Light Eruptions , A. M. A. Arch. Dermat. & Syph. 70:61-66, 1954. 14. Ayers, S., III, and Ayres, S., Jr.: Chloroquine in Treatment of Lichen Planus and other Dermatoses , J. A. M. A. 157:136-138, 1955. 15. Rimington, C.: Haems and Porphyrins in Health and Disease II . Acta med. scandinav. 143:177-196, 1952. 16. Brunsting, L. A.: Observations on Porphyria Cutanea Tarda , A. M. A. Arch. Dermat. & Syph. 70:551-564, 1954. 17. Watson, C. J., and Larson, E. A.: The Urinary Coproporphyrins in Health and Disease , Physiol. Rev. 27:478-510, 1947. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Dermatology American Medical Association

Acute Porphyria and Coproporphyrinuria Following Chloroquine Therapy: A Report of Two Cases

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Publisher
American Medical Association
Copyright
Copyright © 1957 American Medical Association. All Rights Reserved.
ISSN
0096-5359
DOI
10.1001/archderm.1957.01550180010003
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Abstract

Abstract The fact that acute intermittent porphyria can be precipitated by various chemicals is well recognized and amply reported in the literature.1-3 The chemicals most frequently described as initiating the clinical picture of acute intermittent porphyria are the barbiturates, sulfonmethane (Sulfonal), sulfonethylmethane (Trional), alcohol, and allylisopropylacetylcarbamide (Sedormid). Waldenström4 first demonstrated that the barbiturates are capable of precipitating acute attacks of porphyria in individuals having latent porphyria but who were previously free of symptoms. In September, 1954, Linden et al.5 reported the case of a patient who had an episode typical of acute intermittent porphyria shortly after receiving chloroquine. This patient was under treatment for six years for chronic discoid lupus erythematosus. Four days after the patient was started on chloroquine therapy, 0.5 gm. daily, he developed chills, low-grade fever, vomiting, and abdominal pain. His urine turned Burgundy red, and tests were positive for uroporphyrin References 1. Watson, C. J.: Porphyria, in Advances in Internal Medicine , edited by W. Dock and I. Snapper, Chicago, The Year Book Publishers, Inc., 1954, Vol. 6, pp. 235-299. 2. Schwartz, S.: Porphyrins and Porphyrin Precursors in Human and Experimental Porphyria , Federation Proc. 14:717-722, 1955. 3. Schmid, R., and Schwartz, S.: Experimental Porphyria: III. Hepatic Type Produced by Sedormid , Proc. Soc. Exper. Biol. & Med. 81:685, 1952. 4. Waldenström, J.: Studien über Porphyrie , Acta med. scandinav. , (Supp.) 82:1-254, 1937. 5. Linden, S. H.; Steffen, C. G.; Newcomer, V. D., and Chapman, M.: Development of Porphyria during Chloroquine Therapy for Chronic Discoid Lupus Erythematosus , California Med. 81:235-237, 1954. 6. Goodman, L. S., and Gilman, A. Z.: The Pharmacological Basis of Therapeutics , Ed. 2, New York, The MacMillan Company, 1955. 7. Berliner, R. W.; Earle, D. P., Jr.; Taggart, J. V.; Zubrod, C. G.; Welch, W. J.; Conan, N. J.; Bauman, E.; Scudder, S. T., and Shannon, J. A.: Studies on the Chemotherapy of the Human Malarias: VI. The Physiological Disposition, Antimalarial Activity, and Toxicity of Several Derivatives of 4-Aminoquinoline , J. Clin. Invest. 27(No. (3) , Pt. 2):98-107, 1948. 8. Titus, E. O.; Craig, L. C.; Golumbic, C.; Mighton, H. R.; Wempen, M., and Elderfield, R. C.: Identification by Distribution Studies: IX. Application to Metabolic Studies of 4-Aminoquinoline Antimalarials , J. Org. Chem. 13:39-62, 1948. 9. Jailer, J. W.; Rosenfeld, M., and Shannon, J. A.: The Influence of Orally Administered Alkali and Acid on the Renal Excretion of Quinacrine, Chloroquine and Santoquine , J. Clin. Invest. 26:1168-1172, 1947. 10. Alving, A. S.; Eichelberger, L.; Craige, B., Jr.; Jones, R., Jr.; Whorton, C. M., and Pullman, T. N.: Studies on the Chronic Toxicity of Chloroquine (SN-7618) , J. Clin. Invest. 27(No. (3) , Pt. 2):60-65, 1948. 11. Craige, B., Jr.; Whorton, C. M.; Jones, R., Jr.; Pullman, T. N.; Alving, A. S.; Eichelberger, L., and Rothman, S.: A Lichen-Planus-like Eruption Occurring During the Course of Chloroquine Administration , J. Clin. Invest. 27(No. (3) , Pt. 2):56-59, 1948. 12. Pillsbury, D. M., and Jacobson, C.: Treatment of Chronic Discoid Lupus Erythematosus with Chloroquine (Aralen) , J. A. M. A. 154:1330-1333, 1954. 13. Rogers, J., and Finn, O. A.: Synthetic Antimalarial Drugs in Chronic Discoid Lupus Erythematosus and Light Eruptions , A. M. A. Arch. Dermat. & Syph. 70:61-66, 1954. 14. Ayers, S., III, and Ayres, S., Jr.: Chloroquine in Treatment of Lichen Planus and other Dermatoses , J. A. M. A. 157:136-138, 1955. 15. Rimington, C.: Haems and Porphyrins in Health and Disease II . Acta med. scandinav. 143:177-196, 1952. 16. Brunsting, L. A.: Observations on Porphyria Cutanea Tarda , A. M. A. Arch. Dermat. & Syph. 70:551-564, 1954. 17. Watson, C. J., and Larson, E. A.: The Urinary Coproporphyrins in Health and Disease , Physiol. Rev. 27:478-510, 1947.

Journal

A.M.A. Archives of DermatologyAmerican Medical Association

Published: Jun 1, 1957

References