Case Presentation
A 17-year-old female patient presented to the emergency department with complaints of severe colicky abdominal pain for the past two days. The patient was having diffuse abdominal pain.
Physical Examination
- The ultrasonography of the abdomen and abdominal X-ray, serum lipase, and amylase level of the patient was normal.
- The blood pressure of the patient was about 150/10 mmHg and she had a pulse rate of 130/min.
- She was tachypneic and disoriented.
- The patient also had a third-person auditory hallucination.
- RBS, serum electrolytes, and oxygen saturation were normal. CT head was normal.
- Renal function tests, liver function tests, and complete blood counts were normal.
Medical History
- The patient used to get similar episodes of abdominal pain for the past 2 years almost every month, 7-8 days following her menstrual period.
- She had consulted multiple doctors but a definite diagnosis was not made.
- She also had a history of seizures 6 years ago for which she was evaluated and she never had a recurrence in this past year therefore she was not on any treatment.
Family History
- No family history of similar complaints was found.
Clinical Examination
- The patient was emaciated and was having diaphoresis and tremors in their hands, no cutaneous lesions were present.
- Because of abdominal pain, neuropsychiatric disease, and associated autonomic dysfunction urine, porphyrin precursor porphobilinogen was done and was positive, hence the diagnosis of Acute Intermittent Porphyria was made.
- Classic discoloration of urine color on exposure to sunlight was also demonstrated.
- Psychiatry consultation was done because of hallucination and the impression of an organic schizophrenia-like disorder was given.
- The patient developed one episode of seizure in the emergency department for which she was hospitalized.
Treatment
- The patient was treated with levetiracetam. However, she developed levetiracetam-induced psychosis and in the opinion of a psychiatrist and neuro physician, she was started on brivaracetam 50 mg BD.
- Following the seizure episode, the patient was drowsy.
- The patient developed acute onset of weakness in both lower limbs.
- She was treated with a high carbohydrate diet and dextrose-containing intravenous fluids, brivaracetam, antipsychotic drugs, and mechanical ventilation.
- Tachycardia was controlled with beta-blockers.
Clinical Outcome
- The patient was admitted to the intensive care units and ventilated and was improving.
- She had regained consciousness and the power of her lower limbs had not improved yet.