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Acute Hepatic Porphyrias in Colombia: An Analysis of 101 Patients

  • Daniel A. Jaramillo-CalleEmail author
  • Daniel C. Aguirre Acevedo
Research Report
Part of the JIMD Reports book series (JIMD, volume 44)

Abstract

Background: There is minimal information available about acute hepatic porphyrias (AHPs) in developing countries. The aim of this study was to describe the demographics, clinical features, and mortality of AHPs in Colombia.

Patients and methods: 121 patients with presumed diagnosis of AHPs were reported in Colombia between 1944 and 2018. A pooled analysis of 53 patients with confirmed diagnosis was performed to evaluate the demographics, clinical features, and mortality of AHPs in the country. Selected variables were compared by periods (1952–2000 and 2001–2018).

Results: Most attacks occurred in women (66%), with a women-to-man ratio of 39/14. 96% of the patients were diagnosed with AHPs between 15 and 40 years of age. Precipitants were identified in 71% of attacks and more than one precipitant in 41% of them. Drugs (85%) and infections (44%) were the most common precipitants. 11% of women had premenstrual attacks. Abdominal pain was the most common symptom (96%). Cortical blindness, posterior reversible encephalopathy syndrome, and rhabdomyolysis were described. 70% of attacks were confirmed by qualitative test only. 67% of attacks were treated with intravenous heme. The use of heme increased from 4 to 85% in the last two decades. Mortality decreased about twofold in relation to the increase in the use of heme. Severe motor neuropathy was associated with increased mortality. Gonadorelin analogues, heme prophylaxis, and orthotopic liver transplantation have been used to prevent recurrent attacks.

Conclusions: Diagnosis and treatment of AHPs in Colombia have improved in recent decades. However, there are still important shortcomings to address.

Keywords

Colombia Developing countries Diagnostic errors Hematin Heme Latin America Mortality Porphyria Rare diseases 

Abbreviations

AHPs

Acute hepatic porphyrias

AIP

Acute intermittent porphyria

ALA

Aminolevulinic acid

ALAS1

Aminolevulinic acid synthase 1

DNA

Deoxyribonucleic acid

GnA

Gonadorelin analogs

HCP

Hereditary coproporphyria

HMBS

Hydroxymethylbilane synthase

NAPOS

Norwegian Porphyria Centre

OLT

Orthotopic liver transplantation

PBG

Porphobilinogen

PRES

Posterior reversible encephalopathy syndrome

RNA

Ribonucleic acid

VP

Variegate porphyria

Notes

Acknowledgment

We thank Jesenia Avendaño and Luis C. Hoyos for helping us obtain the articles.

Supplementary material

477624_1_En_125_MOESM1_ESM.doc (66 kb)
Supplementary Material (DOC 65 kb)

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Copyright information

© Society for the Study of Inborn Errors of Metabolism (SSIEM) 2018

Authors and Affiliations

  • Daniel A. Jaramillo-Calle
    • 1
    Email author
  • Daniel C. Aguirre Acevedo
    • 2
  1. 1.Colombian Porphyria Research Group (PorfiCol)IPS Universitaria – Universidad de AntioquiaMedellínColombia
  2. 2.Institute of Medical Research, Universidad de AntioquiaMedellínColombia

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