Porphyria cutanea tarda is usually a benign disease of insidious onset in older patients and is associated with few or no systemic symptoms except a mild degree of hepatic insufficiency. In most patients signs of the disease are limited to the skin. In such cases porphobilinogen is absent, although large amounts of uroporphyrin and coproporphyrin are excreted in the urine and feces.
Occasionally instances occur in which features of classic porphyria of the intermittent type may be combined with porphyria cutanea tarda, the so-called mixed type. The disease is known to recur intermittently for years, with an unusual combination of symptoms which are likely to cause the patient to be labeled a neurotic by the succession of physicians in attendance.
The patient's complaints may be those of severe, recurring abdominal pains and colics. Thinking that such patients have a surgical condition of the abdomen, some surgeons