Hyperammonemia syndrome due to Ureaplasma infection after liver‐kidney transplant

Abstract

Hyperammonemia syndrome, with high levels of ammonia and neurologic dysfunction, is a syndrome with historically high mortality that may occur after solid organ transplantation. Recently, this has been associated with infection due to Ureaplasma, mostly following lung transplantation. We describe the first case of hyperammonemia syndrome due to Ureaplasma infection after liver‐kidney transplantation. Our patient rapidly recovered after specific antibiotic treatment. It is important to consider these infections in the differential diagnosis for encephalopathy post‐transplant, as these organisms often do not grow using routine culture methods and polymerase chain reaction testing is typically required for their detection. This is particularly critical after liver transplantation, where a number of other etiologies may be considered as a cause of hyperammonemia syndrome.

Hyperammonemia syndrome due to Ureaplasma urealyticum in a kidney transplant recipient: A case of disseminated disease from a fluoroquinolone‐resistant isolate

“…Given her aseptic pyuria, arthritis, and fever, blood and urine ity rates. 2,4,6,8,11,22 Notably, many infections have been described in hosts with hypogammaglobulinemia from administration of rituximab, 1,4,5,23 rather than transplant recipients. While the exact pathophysiology is unclear, hypogammaglobulinemic patients appear to be more susceptible to colonization of mucous membranes, especially of the urogenital tract, and progression to invasive disease.…”

“…infections, with or without microbiologic confirmation. 5,9,11 In one KT patient with HS and negative urine cultures, an occult urea cycle disorder was diagnosed, without additional microbiological testing. 16 Based on our case and emerging literature, we favor early molecular testing and specific media culture for Mycoplasma and Ureaplasma spp.…”

“…isolates, especially those from extragenital samples, and may support initial empiric use of two antimicrobial agents. 6,9,11,25 Our case study has several limitations: First, we do not have Ralph Rogers https://orcid.org/0000-0003-0268-0188…”

“…It is associated with high mortality and neurological sequelae, despite conventional ammonia‐lowering therapies 6,7,10 . Some clinicians have used empiric treatment with two antibiotics, 6,9,11 although resistance of these organisms to the usually effective antimicrobials (fluoroquinolones, macrolides, tetracyclines) is considered rare 12,13 . To our knowledge, seven cases of HS in kidney transplant (KT) recipients have been published to date 9,14‐19 .…”

“…9,[14][15][16][17][18][19] Four were attributed to infection, two from Mycobacterium spp., 15,18 one from U parvum, 19 and one from Ureaplasma spp. 11 We present a unique case of HS caused by U. urealyticum infection in a KT recipient. Additionally, we describe one of the very few cases of Ureaplasma spp.…”