Case history
We herein report a case of successful treatment of H. pylori in a female patient with porphyria. The patient, who was in her 20s, suffered from alcohol-induced whole body pain, constipation, hypertension, tachycardia, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and epileptic seizures triggered. Elevated porphyrin precursors in the urine led to the diagnosis of acute intermittent porphyria. Hemin administration (the details of which we had previously reported)4 promptly improved her symptoms. Thereafter, she experienced recurrent menstrual-related porphyria attacks that presented as constipation, abdominal pain, and leg pain. Constipation and elevated urinary porphyrin precursor levels regularly coincided with the period after ovulation; thus, we considered constipation as a symptom of mild porphyria. We hypothesize that the patient’s constipation resulted from vasospasm-induced ischemia caused by nitric oxide synthase deficiency.4 Once a month, on the day before or after she was expected to ovulate, the patient was intravenously administered 0.4 mg/kg of hemin (Figure. 1). This drug, which remains in the body for approximately three weeks, was safely administered without increasing the patient’s ferritin levels. For four years after the start of hemin treatment, the patient maintained a stable course without severe attacks.
One day, she complained of upper abdominal pain unrelated to porphyria and was evaluated by upper gastrointestinal endoscopy. Chronic inflammation was observed in her gastric mucosa, and a rapid urease test was positive; thus, she was diagnosed with H. pylori –related chronic gastritis. The patient’s medication regimen was modified such that hemin was administered at the onset of constipation; and clarithromycin, vonoprazan, and amoxicillin were administered for 1 week after the onset of menstruation (Figure. 1). This protocol eliminatedH. pylori without triggering porphyria symptoms such as constipation.