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Luder AS, Mamet R, Farbstein I, Schoenfeld N. Awareness is the name of the game: clinical and biochemical evaluation of a case of a girl diagnosed with acute intermittent porphyria associated with autism. Cell Mol Biol (Noisy-le-grand) 2009; 55:19-22. [PMID: 19267997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/17/2009] [Indexed: 05/27/2023]
Abstract
Neuroporphyrias, a heterogeneous group of metabolic diseases, are diagnosed less often than their true prevalence justifies. Lack of awareness of porphyrias and their protean clinical and biochemical manifestations, is the most significant hurdle to their recognition and diagnosis. These points are reflected in the unusual case reported here, which highlights the potential damage that inappropriate management may cause when the diagnosis is missed over a long period. We diagnosed heterozygous Acute Intermittent Porphyria (AIP) in a 15 yr old girl, who first presented with autism at the age of 4 years. This phenotypic association has not been previously reported. In addition to the unrecognized phenotype, her normal urinary aminolevulinic acid and porphobilinogen, findings which are not compatible with symptomatic porphyria according to well established criteria, could also have led to a missed diagnosis of neuroporphyria. However, the diagnosis of AIP was established on the basis of a 64% reduction in erythrocyte hydroxymethylbilane synthase (HMBS) activity and the finding of a known causative AIP mutation (p.D178N). We therefore recommend that porphyria should be considered in autistic children especially when there is an atypical course or unexpected abreaction to medications. The biochemical and genetic data should be carefully evaluated in a specialized porphyria center.
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Legrand DA, Borgoens P, Lancellotti P. [Acute intermittent porphyria: a rare contra-indication to acute myocardial infarction treatment]. REVUE MEDICALE DE LIEGE 2008; 63:528-531. [PMID: 19051507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The treatment of acute myocardial infarction as described in guidelines, generaly meets with few contra-indications. In our clinical practice, we have met an exceptional one: acute intermittent porphyria. This disease is characterized by acute abdominal pain, neurologic disturbances and cardiac arrhythmias related to different stimuli such as some drugs. Among these drugs, several molecules are usually used for treatment of acute coronary syndromes. Knowledge of these the therapies is crucial to avoid some dangerous consequences.
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Meersseman W, Cassiman D, Goossens W, Vanderschueren S. An unusual cause of syndrome of inappropriate antidiuretic hormone secretion. Acta Clin Belg 2008; 63:277-80. [PMID: 19048708 DOI: 10.1179/acb.2008.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 22-year-old woman was admitted to intensive care with severe hyponatraemia. She suffered from lower abdominal pain, vomiting and irritability since one week. Physical findings showed euvolemia and an altered mental status with severe agitation and slurred speech. Abdominal examination was painful but there were no signs of peritonitis. Laboratory data were compatible with the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone. Since patient was in a premenstrual phase, recently started to take an oral contraceptive and since no abnormalities were seen on an abdominal CT scan, the presentation was considered suggestive of an acute porphyria attack. A urinary sample indicated markedly increased levels of delta-aminolevulinic acid, porphobilinogen and uroporphyrin. A low activity of the porphobilinogen deaminase enzyme confirmed the diagnosis of acute intermittent porphyria. The present case demonstrates the need for a high level of suspicion in order to diagnose this disorder in unexplained syndrome of inappropriate antidiuretic hormone secretion and prevent life-threatening complications.
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de Los Ríos CC, Durán FG, Moros ET, Martín JAC, Alcol BP. [Abdominal pain and inadequate antidiuretic hormone secretion in a patient diagnosed with acute intermittent porphyria]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2008; 100:247-248. [PMID: 18563987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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55
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Wolff C, Armas Merino R. [Porphyria and pregnancy. Review of 17 women]. Rev Med Chil 2008; 136:151-156. [PMID: 18483667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Hormonal changes, prolonged fasting due to vomiting and some medications used during pregnancy, may cause an acute crisis of porphyria, sometimes unveiling a latent disease. Porphyria may also affect the evolution of pregnancy. AIM To study the reciprocal influence in the evolution of both pregnancy and porphyria. MATERIAL AND METHODS Retrospective review of medical records of women with porphyria followed by the authors. If additional information was required, an additional visit to the clinic was scheduled. The characteristics of pregnancy, delivery and the newborn were analyzed. RESULTS Information about 60 pregnancies in 17 women aged 18 to 43 years was gathered. Among women with acute porphyria, one with coproporphyria had four pregnancies, nine with variegate porphyria had a total of 34 pregnancies and two with acute intermittent porphyria had six pregnancies. Five women with porphyria cutánea had a total of 16 pregnancies. Influence of porphyria in pregnancy: Compared to the general population, no differences were observed in birth weight of newborns, frequency of gestational hypertension, term or preterm deliveries of live newborns, spontaneous abortions nor in tubal pregnancies; there was a high frequency of hyperemesis gravidarum. Influence of pregnancy in porphyria: 5 of the 12 patients with acute porphyria, had an acute porphyria crisis, 3 during the puerperal period and 2 during pregnancy (42% of women, 11% of pregnancies). All these crisis were associated to the administration of medications. All patients survived. Two of these women had six ulterior pregnancies without complications. CONCLUSIONS Women with porphyria that become pregnant have a higher frequency of hyperemesis gravidarum. Crises among women with acute porphyrias, were always associated with the use of potentially dangerous medications.
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García-Martul M, Santana-Cabrera L, Santos-Moyano Z, Sánchez-Palacios M. [Rhabdomyolysis after correction of severe hyponatremia due to an attack of acute intermittent porphyria]. Nefrologia 2008; 28:563-564. [PMID: 18816221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Pustovoĭt IS, Glasko EN, Iatskov KV, Karpova IV, Shulutko EM, Petrova VI, Kozlova SI, Korolev AV, Kremenetskaia AM, Biriukova LS, Kravchenko SK, Vorob'ev AI. [Infectious-septic complications in acute intermittent porphyria aggravated by chronic renal failure]. TERAPEVT ARKH 2008; 80:67-70. [PMID: 18763602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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58
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Glasko EN, Pustovoĭt IS, Korolev AV, Karpova IV. [A case of the long course of acute intermittent porphyria]. Arkh Patol 2007; 69:39-42. [PMID: 18290381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A case of acute intermittent porphyria is described in a 37-year-old female patient treated with normasang, a drug that regulates porphyrin metabolism at the last stages of the disease. Chronic renal failure with the hypertensive syndrome, severe neurological symptoms, and vascular sclerotic changes in all organs were the symptoms of the underlying disease. Infectious complications were the cause of sepsis and favoured deteriorated multiple organ dysfunction that determined lethal exitus.
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Kuo HC, Lee MJ, Chuang WL, Huang CC. Acute intermittent porphyria with peripheral neuropathy: A follow-up study after hematin treatment. J Neurol Sci 2007; 260:231-5. [PMID: 17459418 DOI: 10.1016/j.jns.2007.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 03/05/2007] [Accepted: 03/21/2007] [Indexed: 11/29/2022]
Abstract
We report a patient with acute intermittent porphyria who presented with progressive motor neuropathy, particularly in the upper limbs. The electrophysiological studies showed an asymmetric motor neuropathy with a prominent involvement of both the radial and left peroneal nerves. During the 1-year follow-up period, 6 courses of hematin infusion, with 150 mg daily for 4 consecutive days every month, were administrated. The motor neuropathy showed a steady and gradual improvement following the hematin treatment. Molecular analysis of the porphobilinogen deaminase gene revealed a short segment deletion (1008-1019delCAGCCTGGCCAA) resulting in a truncated protein. The findings suggest that early hematin treatment is temporally associated with interval improvement of the patient's porphyric motor neuropathy.
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60
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Annigeri RA, Ganesan VM. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis due to acute intermittent porphyria, successfully treated with haemodialysis. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2007; 55:667-669. [PMID: 18051744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report an eighteen year old female, a case of acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion, as presenting feature for its rarity. The neurological crisis was successfully treated with haemodialysis.
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61
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Stewart MF, Croft J, Reed P, New JP. Acute intermittent porphyria and phaeochromocytoma: shared features. J Clin Pathol 2007; 60:935-6. [PMID: 17660335 PMCID: PMC1994495 DOI: 10.1136/jcp.2005.032722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Storjord E, Brekke OL, Nielsen EW. Safe usage of isotretinoin in a woman with latent acute intermittent porphyria. Acta Derm Venereol 2007; 87:267-8. [PMID: 17533497 DOI: 10.2340/00015555-0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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63
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Hsieh CH, Tsai HH, Lu TH, Chen YC, Hsieh MW, Chuang YC. Acute intermittent porphyria with peripheral neuropathy complicated by small-fiber neuropathy. Neuropathology 2007; 27:133-8. [PMID: 17494514 DOI: 10.1111/j.1440-1789.2006.00751.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a 60-year-old male patient with acute intermittent porphyria (AIP) who presented with initial abdominal pain and subsequent quadriplegia and respiratory failure. Small fiber neuropathy was demonstrated by measuring intra-epidermal nerve fiber density (IENFD) using protein gene product 9.5 (PGP 9.5) immunostaining on three consecutive skin punch biopsies of the distal lower limb. The biopsy findings demonstrated some correlation with progression of the patient's clinical condition. Neuropathy in AIP can have a small-fiber component rather than being solely a large-fiber neuropathy.
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64
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Tziperman B, Garty BZ, Schoenfeld N, Hoffer V, Watemberg N, Lev D, Ganor Y, Levite M, Lerman-Sagie T. Acute intermittent porphyria, Rasmussen encephalitis, or both? J Child Neurol 2007; 22:99-105. [PMID: 17608316 DOI: 10.1177/0883073807299962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of a young woman who suffers from refractory epilepsy in the form of Rasmussen encephalitis and acute intermittent porphyria is presented. The patient developed refractory partial seizures with progressive hemispheric atrophy in the first decade. Both her serum and cerebrospinal fluid contained significantly elevated levels of anti-GluR3B antibodies. Her serum also contained anti-NR2A antibodies (directed against the N-methyl-D-aspartate receptor). Seven years later, acute intermittent porphyria was diagnosed as she developed an acute episode of abdominal pain, dark urine, and hyponatremia. For several years, all attempts to discontinue porphyrinogenic antiepileptic drugs such as phenobarbital and valproate resulted in seizure worsening. During a major acute intermittent porphyria crisis, brain edema and coma developed, allowing the discontinuation of phenobarbital. On recovery, atrophy of the right hemisphere ensued. Several etiologic hypotheses are presented. Double insults, porphyria, and an autoimmune process are suggested for the development of Rasmussen encephalitis in this patient. The authors recommend testing for porphyria in cases of Rasmussen encephalitis and other intractable seizures.
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Weinzierl A, Brezinka C, Engelhardt K. Unusual Manifestation of Acute Hepatic Porphyria in Pregnancy. Fetal Diagn Ther 2006; 22:136-8. [PMID: 17139171 DOI: 10.1159/000097113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/18/2006] [Indexed: 11/19/2022]
Abstract
A 22-year-old para I/gravida II developed psychiatric symptoms at 8 weeks of gestation. Subsequently neurological symptoms with seizures developed leading to a status epilepticus with continuing seizures at week 14. Anticonvulsive therapy had little effect in alleviating the seizures and the condition of the patient rapidly deteriorated. A sudden reddening of her urine lead to the diagnosis of acute hepatic porphyria confirmed by laboratory tests. After extensive discussion with the patient's family it was decided to terminate the pregnancy at week 16. Within hours after pregnancy termination the seizures stopped and the patient recovered without any neurological deficits. Acute hepatic porphyria can be triggered by pregnancy and usually presents with gastrointestinal symptoms and personality changes. In its rare neurological manifestation it can lead to untreatable convulsions which leave no option but to terminate the pregnancy.
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66
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Kristiansen C, Langkjer ST. Treatment and treatment considerations in a patient with advanced breast cancer and acute intermittent porphyria. Acta Oncol 2006; 45:337-9. [PMID: 16644579 DOI: 10.1080/02841860500434697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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67
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Abstract
The differential diagnosis of abdominal pain with associated hyponatraemia should include acute intermittent porphyria. Development of hyperthyroidism in a patient with latent porphyria may precipitate an acute attack and increase disease severity. Treatment of hyperthyroidism may prevent recurrent episodes.
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68
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Obon-Azuara B, Gutierrez-Cia I, Villanueva-Anadon B, Millastre-Bocos E. [Neurologic disorders associated with acute intermittent porphyria]. Rev Neurol 2006; 43:378-80. [PMID: 16981171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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69
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Hsieh CH, Hung PC, Chien CT, Shih YR, Peng SK, Luk HN, Tsai TC. The use of rocuronium and sevoflurane in acute intermittent porphyria--a case report. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2006; 44:169-71. [PMID: 17037005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Acute intermittent porphyria (AIP) is an inherited metabolic disorder caused by deficiency of porphobilinogen deaminase, an enzyme found in the synthetic pathway of heme. Acute attack of AIP may be precipitated by many factors during operation and anesthesia, including fasting, dehydration, stress, infection, and drugs. Acute attack of AIP is likely fatal. Therefore, the drugs recommended as being safe in anesthesia for porphyria patients are up-to-dately refreshed and renovated and the identification of whether a drug is safe or not is based on cumulative anecdotal experiences. Here, we report the safe use of rocuronium and sevoflurane for long exposure in a patient affected with acute intermittent porphyria.
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Wang JG, Guarnaccia M, Weiss SF, Sauer MV, Choi JM. Initial presentation of undiagnosed acute intermittent porphyria as a rare complication of ovulation induction. Fertil Steril 2006; 86:462.e1-3. [PMID: 16769059 DOI: 10.1016/j.fertnstert.2005.12.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 12/26/2005] [Accepted: 12/26/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To discuss the diagnosis and management of acute intermittent porphyria following ovulation induction. DESIGN Case report. SETTING Academic IVF center. PATIENT(S) A patient with polycystic ovary syndrome and primary infertility undergoing ovulation induction with clomiphene citrate. INTERVENTION(S) Serial phlebotomy, IV fluid, inpatient observation. MAIN OUTCOME MEASURE(S) Condition at discharge. RESULT(S) The patient was diagnosed with severe hyponatremia caused by acute volume depletion and possible syndrome of inappropriate antidiuretic hormone secretion, secondary to acute intermittent prophyria, and was successfully managed with supportive measures. Neurovisceral symptoms resolved, and severe hyponatremia was corrected with IV saline solution without complications. CONCLUSION(S) Acute intermittent porphyrias are rare complications of ovulation induction, but should be considered in patients who develop unexplained hyponatremia or neurovisceral symptoms.
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Krayenbühl PA, Naumann KU, Käser L, Vetter W. [Acute intermittent porphyria]. PRAXIS 2006; 95:701-7; quiz 708. [PMID: 16722400 DOI: 10.1024/0369-8394.95.18.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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73
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Hadary A, Dinai Y, Shoshany G, Cozacov JC. Acute intermittent porphyria associated with hypoganglionosis in a young adult. Gut 2006; 55:581-2. [PMID: 16531540 PMCID: PMC1856198 DOI: 10.1136/gut.2005.087049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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74
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Sahu MT, Rajaram S, Saxena AK, Goel N, Ghumman S. Medical Termination of Pregnancy in Acute Intermittent Porphyria. Gynecol Obstet Invest 2006; 62:38-40. [PMID: 16514240 DOI: 10.1159/000091835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 01/18/2006] [Indexed: 11/19/2022]
Abstract
Acute intermittent porphyria is a rare autosomal dominant disease characterized by acute attacks of neuropsychiatric and neurovisceral dysfunction. In pregnancy, exacerbation of attacks in the form of seizures and acute abdomen occur due to hormonal changes. We report the case of a young woman presenting at 8 weeks of gestation requesting pregnancy termination. The patient suffered several episodes of acute abdomen and seizures in a prior pregnancy before the diagnosis was clinched. This case is reported because of its rarity and the limited obstetric experience of this disorder. Proper management depends on avoidance of precipitating factors. Anaesthetic drug safety in porphyria is reviewed and the choice of regional anaesthesia discussed.
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Tiufekchieva E, Dimitrova V. [Acute intermittent porphyria and pregnancy (case report)]. AKUSHERSTVO I GINEKOLOGIIA 2006; 45:49-53. [PMID: 16889201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A case of acute intermittent porphyria [AIP] known before pregnancy is reported in a patient who delivered by elective caesarean section. The pathogenesis of the disease, its symptoms and diagnosis are described as well as specific aspects of its clinical manifestation and differential diagnosis during pregnancy The therapeutic approach both during and out of pregnancy is discussed.
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