AUTHOR=Yan XiaoLi , Xu ZhongSen , Huang ZiYing , Chen JinSen , Ye MengTing , Huang YuLin , Wang ChenChen 
  
TITLE=A type 2 diabetes patient with three years of persistent abdominal pain: the culprit was variegate porphyria—a case report
  
JOURNAL=Frontiers in Endocrinology
  
VOLUME=Volume 17 - 2026
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1777122
  
DOI=10.3389/fendo.2026.1777122
  
ISSN=1664-2392
  
ABSTRACT=IntroductionVariegate porphyria (VP) is a rare metabolic disorder. Its diagnosis is challenging when cutaneous features are absent and symptoms overlap with common conditions like diabetic neuropathy.Case presentationWe report a 71-year-old female with a 30-year history of type 2 diabetes and a 3-year history of mild chronic abdominal pain and psychiatric symptoms. Extensive workup for common abdominal pathologies was negative. A positive urine sun exposure test prompted genetic analysis, which identified a heterozygous pathogenic variant in the PPOX gene (c.567A>C, p.Gln189His), confirming VP. Her mild acute attack was managed successfully with intravenous glucose and safe psychotropic agents, alongside adjusted glycemic targets to prevent catabolism.ConclusionThis case underscores that VP can present atypically without skin lesions. It highlights the importance of considering VP in diabetic patients with unexplained neurovisceral symptoms and demonstrates that mild attacks can be managed with tailored supportive care.