What are the key clinical features that suggest a diagnosis of porphyria in a patient presenting with abdominal pain and neurological symptoms?

Key clinical features suggesting porphyria in a patient with abdominal pain and neurological symptoms include:

• Severe, unexplained abdominal pain often without clear physical findings, which is a hallmark of acute hepatic porphyrias NICE NG239 Gázquez Sisteré et al. 2010.
• Neurological symptoms such as peripheral neuropathy, muscle weakness, seizures, and autonomic dysfunction (e.g., tachycardia, hypertension) are common and may accompany or follow abdominal pain Oliveira Santos 2021 NICE NG239.
• Psychiatric manifestations including anxiety, confusion, hallucinations, or psychosis can be present, reflecting central nervous system involvement Anderson et al. 2022 Oliveira Santos 2021.
• Red or dark urine due to porphyrin precursors excretion may be noted, especially during attacks, serving as a clinical clue Anderson et al. 2022 NICE NG239.
• Triggers such as certain drugs, fasting, hormonal changes, or infections often precipitate attacks, so a history of exposure to these factors supports the diagnosis Anderson et al. 2022 NICE NG239.
• Absence of other causes for the symptoms after routine investigations, especially when abdominal pain is recurrent and accompanied by neurological signs, should raise suspicion of porphyria Gázquez Sisteré et al. 2010 NICE NG239.

In summary, the combination of severe unexplained abdominal pain with neurological and psychiatric symptoms, red/dark urine, and known precipitating factors strongly suggests porphyria and warrants specific biochemical testing NICE NG239 Anderson et al. 2022.