Erythropoietic protoporphyria (EPP) is a rare inherited disorder of the heme 
biosynthesis pathway resulting in the accumulation of protoporphyrins in the 
blood, erythrocytes, and other tissues. Because of a gene mutation in the FECH 
gene, ferrochelatase, the enzyme involved in the final step of heme synthesis, 
is deficient in these patients. Although the major symptom of this disorder is 
photosensitivity, rarely, it can cause progressive liver disease requiring liver 
transplantation (LT). However, LT is not curative and only bone marrow 
transplantation (BMT) can correct the underlying enzymatic defect. Because liver 
disease results from accumulation of protoporphyrin in the liver, LT without 
hematopoietic stem cell transplantation leaves the new liver at risk for similar 
EPP-related damage. A handful of pediatric patients undergoing sequential LT and 
stem cell transplantation have been described in the literature; however, to 
date none has been described in detail in adults. We report a case of an adult 
male with EPP and liver failure who successfully underwent a sequential liver 
and hematopoietic stem cell transplantation (HSCT).