Late Acute Intermittent Porphyria Attack In A Patient With Type 2 Diabetes

Background. Acute intermittent porphyria (AIP) is a hereditary metabolic aberration resulting from a partial defect in the activity of the enzyme porphobilinogen deaminase (PBDG) during the course of haeme synthesis. Diabetic metabolism may attenuate the episodes of porphyria related symptoms.Case report. Our subject (male; age 75) was hospitalized one week after onset of diffuse abdominal pain and constipation and overt type 2 diabetes mellitus (DM). The patient’s long history of alcohol intake with acute alcohol consumption 12 days before admission, in the presence of abdominal pain with spectacular remission after oral administration of 5% glucose solution, accompanied by a 2.5 fold increase of urinary porphobilinogen with normal values for porphyrins and urinary lead, and normal full blood count establishes the diagnosis of AIP.Conclusion We describe a case of AIP probably triggered by acute alcohol consumption, with neurovisceral dominant clinical picture mimicking an acute abdomen. Late disease occurrence as first acute episode at older age accompanied by overt type 2 DM, suggests a latent type of AIP in our patient. The appropriate recognition of latent AIP cases in proband’s offspring prevents unnecessary blind surgery when repeated episodes of unexplained abdominal pain occur.