Acute Transverse Myelitis as a Complication of Glandular Fever

Abstract

MEDICATL JOUNAL difference between the means of isomer III excretion (tg./24 hr.). DiscussionThe bone-marrow and the liver are the principal sites of the haem synthesis, though nearly every living cell is able to synthesize this chromogen.Numerous experimental and clinical investigations have indicated that the haem synthesis is affected in the bone-marrow by certain heavy metals and in the liver by some chemical substances and drugs (Goldberg and Rimington, 1962 ; Schmid, 1963).Impaired liver function is frequently observed after oral contraceptives (Eisalo et al., 1964(Eisalo et al., , 1965) ) and it is evident from the present work that they often also affect the porphyrin metabolism.The accurate mechanism which causes increased ALA excretion in healthy females taking oral contraceptives is not known and is a matter of speculation only.It may be easier to explain the increased proportion of coproporphyrin I in the urine.The urinary excretion of coproporphyrin I is distinctly increased in non-alcoholic cirrhosis, obstructive jaundice, and acute hepatitis.Intrahepatic cholestasis is the dominant factor causing partial transfer of type I coproporphyrin, normally excreted in the bile, to the blood and urine (Aziz et al., 1964).The increased proportion of coproporphyrin I in urine with a normal total urinary coproporphyrin excretion seen in our treated cases may be regarded as a sign of a relatively mild liver functional impairment.The observations of Eisalo et al. support the above assumption.Though the impairment in liver function is in most cases mild, it may in some cases be more severe.An example of this is Case 34 in our series.This patient developed cholestatic jaundice after taking an oral contraceptive for three months. SummaryUrinary excretion of 8-aminolaevulic acid, porphobilinogen, and coproporphyrin was studied in 22 healthy women of child- bearing age on oral contraceptives.The mean excretion of 8-aminolaevulic acid was significantly higher than the mean excretion in a control group of 21 women.There was no significant difference in the excretion of porphobilinogen in the two groups.Total coproporphyrin was normal in every case, but the study of isomer distribution in 15 cases revealed a higher mean isomer I content than normally.The possible mechanisms which cause these changes are discussed.