A 48-year-old woman with porphyria cutanea tarda has a serum ferritin of 480 ng/mL and no evidence of cirrhosis. Which intervention addresses the underlying hepatic abnormality and reduces uroporphyrin excretion?

• A Broad-spectrum oral antibiotics
• B Oral ferrous sulfate supplementation
• C Long-term high-dose systemic corticosteroids
• D Serial phlebotomy until ferritin approaches the lower normal range ✓

Explanation

Iron overload inactivates hepatic uroporphyrinogen decarboxylase by promoting oxidative damage, so removing iron by repeated phlebotomy restores enzyme activity and induces remission; the target is a low-normal ferritin, not iron deficiency. Low-dose chloroquine or hydroxychloroquine is an alternative that mobilises stored uroporphyrin. Iron supplementation worsens disease, and steroids or antibiotics have no role in correcting the hepatic defect.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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