Acute intermittent porphyria: abdominal pain, weight loss and acute neuropathy

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17 Oct 2026 0 comments

A woman in her 20s was admitted in early 2025 with severe generalised abdominal pain for 3 weeks, intractable vomiting, profound constipation and rapid weight loss from 60 kg to 45 kg. She had been previously well. The illness was initially attributed to presumed food poisoning, as several family members had experienced a self-limiting gastrointestinal illness. Her symptoms persisted, and during the admission, she developed gradually progressive, symmetrical weakness affecting all four limbs.

Initial blood tests showed mildly deranged liver function and a pre-renal acute kidney injury. CT and ultrasound scans of the abdomen and pelvis showed faecal loading and a small polypoid gallbladder lesion, but no other abnormality. Following intravenous fluids, electrolyte replacement and bowel regimens, her abdominal symptoms improved. She was diagnosed with gastroenteritis and discharged after 1 month. Her limb weakness improved partially with physiotherapy and was attributed to deconditioning and malnutrition.

One month later, she was readmitted with recurrent...