Rao W, Li L, Wu L, Chai W, Li J. A case report of acute intermittent porphyria presenting with reversible cerebral vasoconstriction syndrome.
Medicine (Baltimore) 2025;
104:e41526. [PMID:
39993084 PMCID:
PMC11856978 DOI:
10.1097/md.0000000000041526]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 01/03/2025] [Accepted: 01/27/2025] [Indexed: 02/26/2025] Open
Abstract
RATIONALE
Acute intermittent porphyria (AIP), an autosomal dominant genetic disorder, is primarily characterized by neuropsychiatric abnormalities and intermittent abdominal pain; however, it is extremely rare for AIP to present with reversible cerebral vasoconstriction syndrome (RCVS).
PATIENT CONCERNS
Herein, we report a case of AIP presenting with RCVS in a patient admitted to our hospital.
DIAGNOSES
We present a case of a 16-year-old female patient with clinical manifestations including abdominal pain, seizures, headache, and peripheral nerve lesions. Laboratory examination revealed small-cell hypochromic anemia, hyponatremia, hypochloremia, and a positive result of the urine porphobilinogen sun exposure test. The peripheral nerve injury was detected via electromyography. A left occipital epileptic discharge was observed on an electroencephalography. Brain magnetic resonance imaging (MRI) revealed abnormal signals in the bilateral temporal, parietal, and occipital lobes, and stenosis in multiple intracranial vasculatures. The patient was found to carry a mutation site in the hydroxymethylbilane synthase (HMBS) gene, and her father was heterozygous.
INTERVENTIONS
After treatment with high glucose, heme arginine, antiepileptic therapy, correction of electrolyte disorders, and nutritional support, the patient's symptoms were improved considerably.
OUTCOMES
Repeat brain MRI showed that the lesion disappeared and the intracranial vasculature returned to normal. The electromyography reexamination results also demonstrated that the peripheral nerve injury was relieved.
LESSONS
RCVS may occur in AIP patients, which is featured with abdominal pain, neuropsychiatric symptoms, and stenosis in multiple intracranial vasculatures. Urine porphobilinogen sun exposure test, brain MRI, and genetic examination can aid in a definitive diagnosis. A high glucose diet, heme arginine, and symptomatic treatment are effective in treating AIP presenting with RCVS.
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