Acute Intermittent Porphyria Attack Triggered by COVID-19 Infection

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 4; p. e37412
• Main Authors: Bardak, Ali Emre, Alada, Mehmet Oğuzcan, Senkal, Naci, Alibeyoğlu, Alpay, Köse, Murat
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 10.04.2023; Cureus
• Subjects: Abdomen; Asymptomatic; Biosynthesis; COVID-19; Cytokine storm; Dehydrogenases; Enzymes; Gastroenterology; Hematology; Hemoglobin; Hepatitis; Infections; Inflammation; Internal Medicine; Kinases; Laboratories; Liver; Metabolism; Muscle pain; Oxygen saturation; Phosphatase; Proteins; Rhabdomyolysis; Severe acute respiratory syndrome coronavirus 2; Urinalysis; Urine; Vitamin E; Istanbul Turkey; Turkey; covid-19; heme metabolism; rhabdomyolysis; hemin; acute intermittent porphyria; porphyria
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.37412

A 45-year-old male patient who was diagnosed with acute intermittent porphyria (AIP) four years ago and had his last episode two years prior presented to our clinic with an AIP attack complicated with rhabdomyolysis triggered by coronavirus disease 2019 (COVID-19) infection. Although there are well-known factors that might trigger an AIP attack, some studies also showed an association of COVID-19 with porphyria. These studies suggest that the accumulation of by-products in the heme synthesis pathway during COVID-19 infection may cause attacks mimicking acute intermittent porphyria. In respect to that, in the early phases of the pandemic, hypotheses emerged arguing the treatment of severe COVID-19 infections with hemin as the treatment of an AIP attack. In our instance, after a two-year period during which there had not been an episode, there was no evident cause other than COVID-19 infection. We believe that patients with porphyria are particularly prone to exacerbations during a COVID-19 infection and should be monitored carefully.