Acute intermittent porphyria (AIP) is rare and the diagnosis is often delayed. It usually presents with abdominal symptoms, behavioural changes,
seizures,
tachycardia, and
hypertension. MRI findings are usually normal or few contrast enhancing lesions may be present. Rarely , reversible vasogenic
edema is seen on MRI as T2 weighted and FLAIR hyper intensity without diffusion restriction suggestive of
posterior reversible encephalopathy syndrome (PRES). Review of literature suggests that there are only few case reports of AIP associated with PRES. Because diffusion-weighted MRI is normal, the lesions are likely caused by reversible vasogenic
edema and transient breakdown of the blood-brain barrier. Treatment of
porphyria consists of a high
carbohydrate diet supplemented with the use of intravenous
glucose and haematin infusions during acute attacks. Management of
seizures with commonly used anti-epileptics including
phenytoin,
valproic acid,
carbamazepine and
barbiturates can worsen symptoms or precipitate acute attacks because of their
enzyme inducing activity.
Levetiracetam is the preferred choice these cases.
Porphyria is an important differential diagnosis in patients with unexplained
abdominal pain along with neuro-psychiatric manifestations. This case report adds to a handful of cases worldwide associating AIP with radiological findings of PRES.