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Diagnosis of acute intermittent porphyria in a renal transplant patient:A case report

World Journal of Transplantation 2022年第1期12卷 8-14页

作者： Cristina Sirch niloufar khanna Lynda Frassetto Francesco Bianco Mary Louise Artero Nefrologia e Dialisi Azienda Sanitaria Universitaria Giuliano IsontinaTrieste 34100Italy Medicine California Northstate UniversityElk GroveCA 95757United States Internal Medicine Division of NephrologyUniversity of California San FranciscoSan FranciscoCA 94193United States

BACKGROUND Acute intermittent porphyria(AIP)is an inherited disorder of porphyrin metabolism with a worldwide distribution and a prevalence ranging from 1 to 9 per million *** is caused by an autosomal dominant-inherited mutation of low penetrance resulting in a deficiency of porphobilinogen deaminase(PBGD)*** attacks are provoked by stressors such as certain medications,alcohol,and *** herein present the first case report of AIP detected in a post-renal transplant *** SUMMARY The patient was a 65-year-old man who underwent transplantation 2 years previously for suspected nephroangiosclerosis and chronic interstitial *** subsequently developed diabetes mellitus which required insulin *** had been treated in the recent past with local mesalamine for *** presented with classic but common symptoms of AIP including intense abdominal pain,hypertension,and *** had multiple visits to the emergency room over a 6-mo period for these same symptoms before the diagnosis of AIP was *** urinary postprandial blood glucose level was 60 mg/24 h(normal,<2 mg/24 h).He was placed on a high carbohydrate diet,and his symptoms slowly *** This case report describes a common presentation of an uncommon disease,in which post-transplant complications and medications may have contributed to precipitating the previously undiagnosed *** hypothesize that the lowcarbohydrate diet and insulin with which our patient was treated may have led to the attacks of ***,our patient’s mesalamine treatment for proctitis may have led to an acute AIP crisis.A high index of suspicion is needed to consider the diagnosis of a heme synthesis disorder,which presents with the common symptoms of abdominal pain,high blood pressure,and anxiety.

关键词： Acute intermittent porphyria Post-transplantation diabetes Mesalamine Tacrolimus Renal transplantation Case report

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