Meet Nisha (name changed), a 24-year-old law student from Bangalore. Ambitious, driven,always juggling exams, internships, and caffeine. But lately, her body has been failing her, and no one knows why.
It started two months ago:
Sudden, cramping abdominal pain, so severe she curled up on the hostel floor. No vomiting, no diarrhea. ER ruled it “gastritis” and sent her home.
Then came the weakness. One day she couldn’t climb stairs without her legs trembling. Then came numbness in her fingers. Two weeks later, she fainted in the library.
Her Doctor ordered basic labs—CBC, LFTs, electrolytes, TSH—all normal.
Then… the psych symptoms began.
She’d wake up panicked, saying she felt “possessed.” She was convinced people were talking about her behind her back. Her roommates thought it was exam stress. A psychiatrist started her on an SSRI.
Then came the seizure.
In the ER, as she was catheterized post-seizure, the intern on duty noticed something weird:
> “Why does her urine look reddish-brown under the fluorescent light?”
Her mother, worried sick, added a curious detail:
> “I think something like this happened to her aunt years ago—she had terrible stomachaches and then stopped talking altogether.”
—
You Run the Following Tests:
*CBC: Normal
*CMP: Sodium borderline low, Creatinine mildly elevated
*LFT: Normal
*CT Abdomen: Normal
*ECG: Sinus tachycardia
*Urine Routine: Negative for RBCs, Positive for porphobilinogen
What’s your diagnosis? What would you order nex? Why is UV Light making her urine “glow”?
Ask for any additional labs or imaging and I’ll provide. Let’s see who catches the real diagnosis first. 
