Hemin Pretreatment Helped Treat Bacterial Infection in AIP Patient

Pretreatment with hemin helped treat a bacterial Helicobacter pylori (H. pylori) infection in a woman with acute intermittent porphyria (AIP), a Japanese case study reports.

The treatment protocol outlined in the report was safely administered to a patient with a history of recurrent acute porphyria attacks.

The study, “Premedication of hemin for eradication therapy of Helicobacter pylori in patients with porphyria,” appeared in the journal Clinical Case Reports.

AIP is caused by the toxic accumulation of porphyrins that function in the production of heme, a component of the oxygen-carrying protein hemoglobin in red blood cells. People with AIP experience recurrent porphyria attacks characterized by abdominal pain and nausea. Such attacks have many potential triggers, including hormonal changes, stress, and medications such as antibiotics.

H. pylori infection is a common cause of stomach ulcers and increases the risk of developing stomach cancer. The antibiotic clarithromycin, the first-line treatment for H. pylori, is thought to be a possible porphyria inducer.

The case report described a woman in her 20s with AIP, whose H. pylori infection was successfully treated without inducing an attack. 

Years before she was diagnosed with H. pylori infection, the patient was admitted to the hospital with alcohol-induced pain, constipation, high blood pressure, elevated heart rate, and epileptic seizures. After a urine test revealed elevated levels of porphyrin precursors, she was diagnosed with AIP. Notably, her sister, who also had elevated levels of porphyrin precursors in urine, was diagnosed with asymptomatic porphyria. 

She was treated with intravenous (into the vein) hemin, which promptly alleviated her symptoms.

The patient then experienced recurrent menstruation-induced porphyria attacks, characterized by abdominal and leg pain, and constipation around ovulation, followed by high blood pressure, and elevated heart rate. Hemin at a dose of 0.4 mg/kg was administered once a month on the day before or after the expected ovulation date.

The treatment was maintained for four years, during which time the patient had no severe attacks. After experiencing abdominal pain not related to AIP, she was diagnosed with a chronic H. pylori infection of the lining of the stomach .

Her treatment routine was modified so that she was treated first with hemin at the onset of constipation, then with a standard H. pylori triple therapy of clarithromycin, vonoprazan, and amoxicillin, administered for one week following menstruation onset. Within five weeks, the infection had been successfully eradicated without symptoms of porphyria.

“We believe that this report might serve as a future reference for eradicating H. pylori in patients with porphyria,” the investigators wrote.

They added that the hemin pre-treatment, followed by standard H. pylori eradication therapy described in the case report may provide guidance in preventing porphyria attacks in people with H. pylori infection. “We present a protocol that can suppress medication-induced porphyria, even in patients with a history of recurrent acute attacks,” they concluded.