Acute intermittent porphyria is an inherited metabolic disease due to de ciency of the enzyme porphobilinogen deaminase that can affect the autonomic, peripheral and central nervous system. We report an 8 year old female who had presented with hyponatremia, psychiatric manifestations, seizures, hypertension and Posterior Reversible Encephalopathy Syndrome (PRES) with a delayed diagnosis of Acute Intermittent Porphyria. As porphyria is thought to be very rare in pre-pubertal age, in view of the

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... potentially fatal outcome of a severe attack, a high index of suspicion is essential.