Acute Intermittent Porphyria features?

• A. Hematuria and flank pain
• B. Jaundice with dark urine at night
• C. Proteinuria and edema
• D. Port-wine colored urine, polyneuropathy, and abdominal pain

Answer: (D)

Acute intermittent porphyria presents with neurovisceral symptoms during attacks. The hallmark combination is severe abdominal pain with vomiting and, importantly, a developing peripheral neuropathy or polyneuropathy—often symmetric and can progress to weakness. A striking clue is urine that is dark, port-wine colored, which darkens further after standing or exposure to air due to oxidation of porphyrin precursors. These features together—abdominal pain, neuropathic weakness, and dark urine—are classic for an acute porphyric crisis. Other patterns like hematuria with flank pain or nephrotic-range proteinuria with edema point to kidney or liver–kidney diseases, not the neurovisceral picture of porphyria.