Science and Education Publishing American Journal of Medical Case Reports 2374-216X 3 5 2015 04 23 Hepatocellular Carcinoma in Acute Intermittent Porphyria: Incidental or Expected? 141 143 EN Mary Mathews Department of Internal Medicine, St. Joseph's Regional Medical Center, New York Medical College Lauren Paish Abhishek Kumar Nazia Khan Michael Maroules AJMCR2015356 10.12691/ajmcr-3-5-6 2015 04 07 2015 04 17 2015 04 23 Acute intermittent porphyria (AIP) is a rare genetic disorder involving an insufficiency of the enzyme porphobilinogen deaminase of the heme biosynthesis pathway. Clinically, this manifests as acute attacks of abdominal pain and neuropsychiatric dysfunction, at times these attacks can be life threatening. Despite an autosomal dominant pattern of inheritance, only a minority develop acute attacks due to poor penetrance, thus representing the manifest and latent type of AIP. A unique association between AIP and Hepatocellular carcinoma (HCC) has been reported by some studies recommended screening recommendations for AIP gene carriers over the age of 50. We report a case of 55 year old Slovakian female with a past medical history of acute intermittent porphyria. She presented to the emergency room complaining of persistent, sharp, right upper quadrant pain with intractable nausea and vomiting. A diagnosis of acute episode of AIP was made, along with incidental finding of hepatocellular carcinoma.