{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:19:25Z","timestamp":1778159965630,"version":"3.51.4"},"reference-count":9,"publisher":"SMC Media","issue":"5","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Acute intermittent porphyria (AIP) is a rare hereditary metabolic disorder in haem biosynthesis that presents with severe abdominal pain. Attacks may be triggered by caloric deprivation. Diagnostic delay is common and reflects non-specific clinical presentations, the rarity of the disease and cognitive biases in clinical decision-making. Case description:\u00a0A 30-year-old woman with opioid and benzodiazepine use disorder presented with abdominal pain and constipation and was initially treated for opioid-induced constipation. Persistent symptoms and hyponatraemia prompted further evaluation, revealing markedly elevated urinary porphyrin precursors. She was diagnosed with AIP and treated with intravenous hemin and high-carbohydrate therapy. Discussion:\u00a0This case illustrates the diagnostic challenge of AIP when plausible alternative explanations such as opioid-induced constipation are present. Persistent symptoms and hyponatraemia due to SIADH served as key clues prompting diagnostic reassessment. Diagnostic overshadowing may have contributed to delayed recognition in the context of substance use disorder. Concurrent severe malnutrition with caloric deprivation likely triggered the attack via accumulation of neurotoxic haem precursors, underscoring the importance of diagnostic flexibility in atypical or non-resolving cases. Conclusion:\u00a0This case underscores the need to consider AIP in patients with severe abdominal pain and atypical clinical courses.<\/jats:p>","DOI":"10.12890\/2026_006584","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:30:47Z","timestamp":1776691847000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute intermittent porphyria mimicking severe coprostasis in a patient on opioid maintenance therapy"],"prefix":"10.12890","volume":"13","author":[{"given":"Carolin","family":"Glatzle","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Gerstend\u00f6rfer","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2065-6698","authenticated-orcid":false,"given":"Armon","family":"Arpagaus","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0471-8699","authenticated-orcid":false,"given":"Flavio","family":"G\u00f6ssi","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"10.12890\/2026_006584_ref1","doi-asserted-by":"crossref","unstructured":"Puy H, Gouya L, Deybach JC. Porphyrias. Lancet 2010;375:924\u2013937. doi: 10.1016\/S0140-6736(09)61925-5","DOI":"10.1016\/S0140-6736(09)61925-5"},{"key":"10.12890\/2026_006584_ref2","doi-asserted-by":"crossref","unstructured":"Wang B, Bonkovsky HL, Lim JK, Balwani M. AGA clinical practice update on diagnosis and management of acute hepatic porphyrias: expert review. Gastroenterology 2023;164:484\u2013491. doi: 10.1053\/j.gastro.2022.11.034","DOI":"10.1053\/j.gastro.2022.11.034"},{"key":"10.12890\/2026_006584_ref3","doi-asserted-by":"crossref","unstructured":"Khan R, Khazaal Y, Thorens G, Zullino D, Uchtenhagen A. Understanding Swiss drug policy change and the introduction of heroin maintenance treatment. Eur Addict Res 2014;20:200\u2013207. doi: 10.1159\/000357234","DOI":"10.1159\/000357234"},{"key":"10.12890\/2026_006584_ref4","doi-asserted-by":"crossref","unstructured":"Bissell DM, Anderson KE, Bonkovsky HL. Porphyria. N Engl J Med 2017;377:862\u2013872. doi: 10.1056\/NEJMra1608634","DOI":"10.1056\/NEJMra1608634"},{"key":"10.12890\/2026_006584_ref5","doi-asserted-by":"crossref","unstructured":"Solares I, Tejedor M, Jeric\u00f3 D, Morales-Conejo M, Enr\u00edquez de Salamanca R, Fontanellas A, et al. Management of hyponatremia associated with acute porphyria\u2014proposal for the use of tolvaptan. Ann Transl Med 2020;8:1098. doi: 10.21037\/atm-20-1529","DOI":"10.21037\/atm-20-1529"},{"key":"10.12890\/2026_006584_ref6","doi-asserted-by":"crossref","unstructured":"Besur S, Schmeltzer P, Bonkovsky, HL. Acute porphyrias. J Emerg Med 2015;49:305\u2013312. doi: 10.1016\/j.jemermed.2015.04.034","DOI":"10.1016\/j.jemermed.2015.04.034"},{"key":"10.12890\/2026_006584_ref7","doi-asserted-by":"crossref","unstructured":"Bonkovsky HL, Maddukuri VC, Yazici C, Anderson KE, Bissell DM, Bloomer JR, et al. Acute porphyrias in the USA: features of 108 subjects from porphyrias consortium. Am J Med 2014;127:1233\u20131241. doi: 10.1016\/j.amjmed.2014.06.036","DOI":"10.1016\/j.amjmed.2014.06.036"},{"key":"10.12890\/2026_006584_ref8","doi-asserted-by":"crossref","unstructured":"Jones S, Howard L, Thornicroft G. \u2018Diagnostic overshadowing\u2019: worse physical health care for people with mental illness. Acta Psychiatr Scand 2008;118:169\u2013171. doi: 10.1111\/j.1600-0447.2008.01211.x","DOI":"10.1111\/j.1600-0447.2008.01211.x"},{"key":"10.12890\/2026_006584_ref9","doi-asserted-by":"crossref","unstructured":"Shefer G, Henderson C, Howard LM, Murray J, Thornicroft G. Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms\u2014a qualitative study. PloS One 2014;9:e111682. doi: 10.1371\/journal.pone.0111682.","DOI":"10.1371\/journal.pone.0111682"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6584\/5464","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6584\/5465","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6584\/5465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:59:10Z","timestamp":1778158750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/6584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":9,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.12890\/2026_006584","relation":{"has-manifestation":[{"id-type":"other","id":"1-167-6584-g5464","asserted-by":"subject"},{"id-type":"other","id":"1-167-6584-g5465","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-167","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}