Successful resolution of hyperammonemia following hematopoietic cell transplantation with directed treatment of Ureaplasma parvum infection

Abstract

Hyperammonemia following hematopoietic cell transplantation (HCT) has been characterized as idiopathic and is associated with a very high mortality. A causal relationship between Ureaplasma infection and hyperammonemia in immunocompromised lung transplant recipients has recently been described. We document the first case of hyperammonemia following HCT associated with Ureaplasma parvum. The initiation of appropriate antibiotics resulted in rapid resolution of hyperammonemic encephalopathy and eradication of the implicating organism.

Mycoplasma and Ureaplasma Infections in Transplantation: A Big Impact Despite the Lack of a Cell Wall

“…Similar to case reports in lung transplant recipients, hyperammonemia in a patient after HSCT has been attributed to U. parvum infection [37]. Twelve days after HSCT, the patient developed an alteration in mental status without focal neurological findings.…”

Successful treatment of Ureaplasma‐induced hyperammonemia syndrome post‐lung transplant

“…Recently, U. parvum was identified by tracheal aspirate PCR in a bone marrow transplant recipient with hyperammonemia syndrome. The patient's ammonia levels and mental status improved after starting Ureaplasma ‐directed antimicrobials …”

Hyperammonemic Encephalopathy due to Ureaplasma parvum Infection in an Immunocompromised Child

“…Authors of previous cases describe therapeutic success with azithromycin monotherapy, levofloxacin and doxycycline, and levofloxacin and azithromycin. 6,16,21 Notably, it is reported that Ureaplasma infection and the accompanying hyperammonemia can relapse after stopping antibiotics. 6,21 The etiology of IHA has eluded clinicians.…”

“…6,16,21 Notably, it is reported that Ureaplasma infection and the accompanying hyperammonemia can relapse after stopping antibiotics. 6,21 The etiology of IHA has eluded clinicians. Multiple factors have been proposed, including chemotherapeutic agents, steroids, sepsis, mucositis, gastrointestinal bleeding, dehydration, and increased nitrogen load from parenteral nutrition.…”