Acquired erythropoietic uroporphyria associated with clonal cytopenia of undetermined significance

Congenital erythropoietic porphyria (CEP) or Günther’s disease is a rare disorder of heme biosynthesis resulting from decreased uroporphyrinogen III synthase (UROS) activity.1,2 In most cases, CEP is a genetic disorder caused by pathogenic germline variants in either UROS or GATA1.3 A small number of late-onset patients with underlying myeloid malignancy, termed acquired erythropoietic uroporphyria (AEU) have been reported with clinical and biochemical features of CEP without detectable pathogenic gene variants.