Acute attack of AIP (acute intermittent porphyria) with severe vivax malaria associated with convulsions: a case report.

Acute intermittent porphyria (AIP) is a hereditary hepatic porphyria inherited as autosomal dominant with low penetrance resulting from mutation in the gene encoding the enzyme, porphobilinogen deaminase (PBG-D) [hydroxymethylbilane synthase, uroporphyrinogen I synthase]. The diagnosis is often obscured by the variable presentation, viz. abdominal pain (commonest), constipation, vomiting, convulsions, and peripheral neuropathy and further complicated by the variable course of illness. Incidence of convulsions is 10–20% but there may be presenting symptom of an acute relapse1,2. Although Plasmodium vivax usually causes benign uncomplicated malaria, it can occasionally result in severe disease with life-threatening, end-organ involvement including cerebral malaria manifesting as convulsions3. This case is a rare presentation of severe vivax malaria and exemplifies the dilemma associated with diagnosis and treatment of convulsions when it occurs in a case of AIP. This case underscores the importance of considering the safety profile of antimalarials and anticonvulsants in a case of AIP.