The vampire in medical perspective: myth or malady?

The vampire is a fascinating creature that has captured man’s imagination ever since its first descriptions. Throughout the years and all over the world it has been portrayed in various—sometimes conflicting, but more often relatively similar—ways in folklore, books and movies. Some well-known examples are the Transylvanian count Dracula, the sasabonsam from West African folklore and the manananggal from the Philippines. The aversion to garlic and sunlight and a victim’s similar fate after a bite seem to be recurring elements.1,2 On closer inspection the physical and behavioral features of the vampire show striking and intriguing similarities with three relatively rare medical conditions discussed in this article: porphyria, rabies and pellagra. The association between vampirism and porphyria is probably the most famous one. Porphyria refers to a group of disorders characterized by a defect in one of the enzymes involved in the synthesis of heme. As a consequence, accumulation of porphyrins (toxic heme precursors) occurs in various organs, depending on the specific subtype.3 Although porphyria cutanea tarda and acute intermittent porphyria are the most common forms, it is congenital erythropoietic porphyria that is in particular associated with vampirism.1 This autosomal recessive disorder, also known as Gunther’s disease, is characterized by pronounced photosensitivity and …