[Abdominal pain and severely impaired consciousness in a 19-year-old female patient]

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.