Acute intermittent porphyria in pregnancy

A 27-year-old, previously healthy normotensive woman was admitted for hyperemesis gravidarum and treated with intravenous fluids and metoclopramide. Thereafter, a neuropsychiatric syndrome developed, with acute asymmetrical axonal motor-sensory polyneuropathy and marked anxiety, depression, irritability, and memory and concentration difficulties. Raised porphyrin precursors were found in the patient’s urine, but not in her feces. Although the association of acute porphyria and pregnancy is rare, the pregnancy itself, combined with a state of starvation, and the administration of metoclopramide, could have precipitated the acute attack in this case. Thiamine deficiency, Guillian- Barre syndrome, and an obstetric complication producing closely related symptoms were excluded. The drug was stopped and the patient was treated with a high-carbohydrate diet and physiotherapy. A normal infant was delivered spontaneously at term.