Clinical problem-solving: Still hazy after all these years

To the Editor: In the medical conundrum presented by Ben-Chetrit and Putterman (Oct. 6 issue),¹ despite a 21-year search for a diagnosis, the patient's illness remains hazy. The diagnosis is most obviously hereditary coproporphyria. The patient and her brother were both affected. The patient had a 21-year history of recurrent abdominal pain, with neither clinical nor surgical peritonitis and in the absence of remarkable sequelae. There was evidence of autonomic disturbances: a rapid pulse, an episode of urinary retention, and decreased peristalsis with dilated loops on a plain film of the abdomen. There was also evidence of neuropsychiatric phenomena: anxiety,.  . .