Abstract
Although the biosynthetic pathway to heme has been well elucidated and errors along that route have been identified and firmly connected to specific diseases, the porphyrias, slight but nonspecific abnormalities, are occasionally invoked as proof of porphyria or in support of other diagnoses. An errant patient with a conundrum of symptoms but without an explanation for them might have to take iatrogenic detours only to learn after what are at times ulyssean vagaries that the initial diagnosis of porphyria is in the end untenable. Thus the porphyrias are superb examples of the interface between laboratory and clinical medicine, in which the occurrence of the Ulysses syndrome can be curtailed through the careful ordering of tests and cogent interpretation of their results.
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