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.