Erythropoietic Protoporphyria and Surgery: A Case of Successful Mastectomy With Perioperative Light Shielding Strategies Based on Light-Induced Hemolytic Threshold Assessment.

A 50-year-old female patient was referred to our department for consultation regarding perioperative management of breast cancer surgery. She had a history of photosensitivity since childhood and was diagnosed with erythropoietic protoporphyria (EPP) during her first pregnancy. Because EPP is classified as a cutaneous porphyria that can cause hemolysis and liver impairment upon light exposure, we conducted a light-induced hemolysis test to determine intraoperative and postoperative exposure thresholds. Hemolysis was observed after 4 h of surgical light exposure. To minimize light-induced hemolysis during surgery, we applied optical films blocking light around the 400 nm wavelength range to the shadowless operating light, monitors, and overhead lamps. Under these conditions, a four-hour surgical procedure was successfully completed. No liver dysfunction or elevation of plasma protoporphyrin levels was observed intraoperatively or postoperatively. This case provided practical guidance for perioperative light management in EPP.