Recurrent Seizures in an Adolescent Female-A Daunting Puzzle

Abstract

Acute porphyrias are metabolic disorders resulting from deficiency of a specific enzyme involved in heme biosynthetic pathway. These deficiencies also affect normal renal physiology, as kidneys are also involved in heme synthesis. Sometimes, this could even lead to end stage renal disease. Acute Intermittent Porphyria, an autosomal dominant disorder arising from half-normal activity of hydroxymethylbilane synthase, is characterized by occurrence of vague neurovisceral attacks (abdominal pain, nausea, vomiting, constipation and neuropsychiatric symptoms), with urinary excretion of porphyrin precursors, such as 5-Amino-levulinic acid (ALA) and Porphobilinogen (PBG). Acute attacks are triggered by dehydration, diarrhea, steroids, low calorie diets. Treatment includes avoidance of precipitating factors, adequate hydration, high carbohydrate diet and heme replacement. Here, we present an adolescent female who had presented with recurrent abdominal pain, dyselectrolyemia with associated seizures, was diagnosed with Acute Intermittent Porphyria and recovered well with symptomatic management.

Keywords: Acute intermittent Porphyria; hydroxymethylbilane synthase; hyponatremia.

Figure 1

On addition of 1 ml of Ehrlich reagent (4-dimethylaminobenzaldehyde) to 1 ml of urine produces port wine color in patient's urine containing PBG

Figure 2

Chloroform is added to the test tubes, mixed well and allowed to settle. Two immiscible layers are formed; with chloroform being heavier, sinks to the bottom and urine being aqueous, stays on top with red color