Document Detail

Variegate porphyria presenting with acute autonomic dysfunction, intussusception and renal infarction.
MedLine Citation:
PMID:  15180190     Owner:  NLM     Status:  MEDLINE    
A 48-year-old man presented with abdominal pain, constipation and irritability one month after starting phenytoin treatment for a generalized seizure. He was hypertensive, tachycardic (BP 174/98, heart rate (HR) 100 bpm supine) and hypovolaemic. Abdominal CT demonstrated transient jejunal intussusception and infarction of the left kidney. Urinary porphobilinogen levels were increased and genetic analysis confirmed the diagnosis of variegate porphyria. Because of ongoing postural hypotension, the patient underwent further autonomic investigations. Levels of blood pressure (MBP), HR and muscle sympathetic activity (MSNA) were increased during the acute attack compared to recovery (131 versus 105 mmHg, 100 versus 60 bpm, 88 versus 26 bursts min(-1)). HR and MSNA did not increase during phase II Valsalva, whereas stroke volume (SV) decays were exaggerated (deltaMBP-56 versus 0-31 mmHg and SV 25% versus 40% baseline). Baroreflex failure causing increased sympathetic activity, decreased sympathetic and parasympathetic rapid responses, loss of splanchnic capacitance and renal salt wasting were the likely mechanisms for postural hypotension. Increased sympathetic activity may also have caused intussusception and focal renal vasoconstriction, both of which may be underdiagnosed causes of abdominal pain in acute porphyria.
J C Griffith; D L Jardine; W Bailey; C M Florkowski
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Scandinavian journal of gastroenterology     Volume:  39     ISSN:  0036-5521     ISO Abbreviation:  Scand. J. Gastroenterol.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-06-07     Completed Date:  2004-10-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0060105     Medline TA:  Scand J Gastroenterol     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  500-3     Citation Subset:  IM    
Dept. of General Medicine, Christchurch Hospital, Christchurch, New Zealand.
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MeSH Terms
Acute Disease
Autonomic Nervous System Diseases / etiology*
Infarction / etiology*
Intussusception / etiology*
Jejunal Diseases / etiology*
Kidney / blood supply*
Middle Aged
Porphyrias, Hepatic / complications,  diagnosis*

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