The diagnosis of acute intermittent porphyria (AIP) is often overlooked. We describe a patient with this condition who had all the 'bells and whistles', in whom the diagnosis was only made after considerable delay. Far from an esoteric condition haunting examination candidates, AIP is an important cause of a broad spectrum of neurological symptoms. Its early recognition allows the astute clinician to prevent potentially devastating sequelae. We provide practical guidance on the investigation and management of this complex disorder. With a 'back to basics' approach to the underlying genetics and biochemistry, we hope to dispel some of the confusion that may obstruct a timely diagnosis.

The challenge in diagnosing the regional ileitis existed since 1932 when Crohn, Ginzberg and Oppenheimer first reported their case1. Many Indian researchers accepted that during last decade there was considerable increase in the incidence of Crohn’s disease (CD) in India which poses great challenge in diagnosing it, due to high prevalence of tuberculosis2. In this perspective we report a case which made a stimulus to review the literature. The purpose of this manuscript is 1. To document the occurrence of an additional case of CD in India, 2. To report that CD can rarely present as post operative enterocutaneous fistula, 3. To discuss the criteria in diagnosing the CD in Tuberculosis (TB) endemic area.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.688-690