Initial presentation of undiagnosed acute intermittent porphyria as a rare complication of ovulation induction.

OBJECTIVE: To discuss the diagnosis and management of acute intermittent porphyria following ovulation induction.
DESIGN: Case report.
SETTING: Academic IVF center. PATIENT(S): A patient with polycystic ovary syndrome and primary infertility undergoing ovulation induction with clomiphene citrate. INTERVENTION(S): Serial phlebotomy, IV fluid, inpatient observation. MAIN OUTCOME MEASURE(S): Condition at discharge. RESULT(S): The patient was diagnosed with severe hyponatremia caused by acute volume depletion and possible syndrome of inappropriate antidiuretic hormone secretion, secondary to acute intermittent prophyria, and was successfully managed with supportive measures. Neurovisceral symptoms resolved, and severe hyponatremia was corrected with IV saline solution without complications. CONCLUSION(S): Acute intermittent porphyrias are rare complications of ovulation induction, but should be considered in patients who develop unexplained hyponatremia or neurovisceral symptoms.