Erythropoietic protoporphyria (EPP) is an inherited disorder caused by loss-of-function mutations in ferrochelatase (FECH), the last enzyme in the heme biosynthesis pathway that converts protoporphyrin IX (PPIX) to produce heme.1, 2, 3 These mutations lead to PPIX accumulation in red blood cells, plasma, and the liver.4, 5, 6, 7 The elimination of PPIX from the body relies on the hepatobiliary system.6 Here, FECH is linked to autosomal erythropoietic protoporphyria.