Healthcare providers evaluating patients presenting with neurological, visceral, or cutaneous symptoms that are disproportionate to the expected severity may need to consider
porphyria in the differential.
Porphyria is an inherited condition in which toxic metabolites of the
heme pathway are increased. Carriers of
porphyrias are asymptomatic and will not present with classical symptoms, nor will levels be elevated, until the disease is induced by certain drugs,
hormones, or idiopathic causes such as the stress of
trauma.
Acute intermittent porphyria, a form of
acute porphyria, is a rare autosomal dominant disease that results in a dysfunctional
porphobilinogen deaminase. This consequently increases neurotoxic
porphobilinogen and subsequent increase in δ-
aminolevulinic acid. Both of these metabolites cause neurovisceral symptoms that afflict the patient in acute attacks. We present a rare case of
acute intermittent porphyria manifested in a
burn patient suffering a
burn injury. The patient presented with symptoms indicative of
acute intermittent porphyria, including altered mental status and
abdominal pain accompanied with a chronic history of
alcoholism and smoking. A negative work-up, including imaging and findings of associated manifestations consistent with
Acute Intermittent Porphyria led to a discovery of elevated
porphyrins. The patient's course and death due to his
injuries gives insight into the presentation of
acute intermittent porphyria in a
burn patient.