A 27-year-old man bearing an erythropoietic protoporphyria (EPP)-associated 
ferrochelatase (FECH) mutation was admitted to our hospital for general malaise 
and marked elevation of the serum levels of hepatobiliary enzymes and bilirubin. 
Initial treatment with plasma exchange did not reduce the blood protoporphyrin 
or serum liver enzyme levels, so phlebotomy was started. Surprisingly, weekly 
phlebotomy normalized the serum levels of liver enzymes, accompanied by a marked 
reduction in the blood protoporphyrin levels. The clinical course of this case 
strongly suggests that phlebotomy may be a suitable treatment option for 
EPP-related hepatopathy.