A Case Report of Porphyria Complicated by PRES: A Trojan Horse Presenting as Dysmenorrhea

Abstract

Acute intermittent porphyria (AIP) is a rare heme synthesis disorder often misdiagnosed due to nonspecific symptoms. Acute attacks feature severe abdominal pain, autonomic nervous system disturbances, and electrolyte imbalances. These can be complicated by posterior reversible encephalopathy syndrome (PRES), presenting with headaches, visual disturbances, confusion, and seizures. In patients with recurrent abdominal pain, autonomic symptoms (e.g., hypertension), or neurologic signs (e.g., seizures or PRES-like features), AIP should be considered. We present a case of a patient with abdominal pain who developed PRES and was later diagnosed with AIP, highlighting the importance of recognizing this condition in such clinical scenarios.