Kozlov Anton, Mybes Cleo, Falk Niklas, Schulze-Hagen Maximilian Franz, Schlecker Stephan, Becher Marc Ulrich
Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstraße 1, 42653, Solingen, Deutschland.
Zentrum für Innere Medizin, Medizinische Klinik III für Geriatrie, Allgemeine Innere Medizin und Nephrologie, Städtisches Klinikum Solingen, Solingen, Deutschland.
Inn Med (Heidelb). 2025 Jul 16. doi: 10.1007/s00108-025-01939-9.
A 19-year-old female patient presented to our clinic with abdominal pain, psychomotor agitation and disorientation. The laboratory analysis revealed severe hyponatremia. Cerebral magnetic resonance imaging (MRI) showed characteristic neuroradiological features of a posterior reversible encephalopathy syndrome (PRES). The detection of a significant increase in the serum concentration of porphyrins confirmed the clinical suspicion of acute intermittent porphyria (AIP). The likely trigger for the sudden AIP exacerbation was the use of levonorgestrel for postcoital contraception. Under treatment with high-dose glucose solution and haem arginate, the abdominal symptoms regressed rapidly. In contrast, neuropsychiatric symptoms improved only gradually, making neurological rehabilitation necessary.
一名19岁女性患者因腹痛、精神运动性激越和定向障碍前来我院就诊。实验室分析显示严重低钠血症。脑部磁共振成像（MRI）显示了后可逆性脑病综合征（PRES）的典型神经放射学特征。血清卟啉浓度显著升高的检测结果证实了临床对急性间歇性卟啉病（AIP）的怀疑。AIP突然加重的可能诱因是使用左炔诺孕酮进行性交后避孕。在高剂量葡萄糖溶液和精氨酸血红素治疗下，腹部症状迅速消退。相比之下，神经精神症状仅逐渐改善，因此需要进行神经康复治疗。
