A Case of Infectious Enterocolitis with Hyperammonemia

Abstract

: Case reports of hyperammonemia due to urease-producing bacteria are found occasionally, but most of them are associated with urinary tract infections. We experienced a case of infectious enterocolitis with hyperammonemia in which the causative bacteria was speculated to be urease-producing bacteria. A Japanese woman in her 70s had been diagnosed with microscopic polyangiitis in a nearby hospital and was transferred to our hospital. Although the microscopic polyangiitis was relatively under control after treatment with steroids and rituximab, frequent diarrhea with hyperammonemia (324 μg/dl) appeared and she became comatose. Her blood ammonia decreased to 47 µg/dl and her consciousness recovered to a normal state after antibiotic treatment for infectious enterocolitis and ammonia detoxification therapy. Liver dysfunction, portosystemic shunt, excessive protein intake and constipation were not observed, and she took no medications that would cause hyperammonemia. Although culture results could not identify urease-producing bacteria, considering the clinical course, acute hyperammonemia was suspected to be due to urease-producing bacteria infection. It is necessary to consider the influence of urease-producing bacteria as a cause of acute hyperammonemia not only in urinary tract infections but also in infective enterocolitis.

Severe non-hepatic hyperammonaemic encephalopathy in an immunocompromised adolescent with enterocolitis

“…Hyperammonaemia secondary to enterocolitis has been reported in humans and is hypothesised to be caused by urease-producing bacteria in the gut. 20 To the best of our knowledge, this is the first case report of hyperammonaemia secondary to enterocolitis in a paediatric patient with an underlying diagnosis of severe aplastic anaemia. In our patient, ammonia levels were more than three times higher than those previously published (1055 µg/dL (620 mmol/L) compared with 324 µg/dL (190 mmol/L)).…”

A novel cause of emergent hyperammonemia: Cryptococcal fungemia and meningitis

“…Ureaplasma infection has also been reported to cause hyperammonemia in an individual following liver-kidney transplant [15] . Infective enterocolitis has been suggested as a cause of hyperammonemia, although no urease-producing bacteria were cultured in the patient [16] .…”

Unexplained Fatal Hyperammonemia in a Patient With New Diagnosis of Acute Monoblastic Leukemia

“…We did not investigate a urea cycle defect by measuring citrulline, ornithine, or arginine levels for several reasons, as this would not have changed our management plan, the test results would have taken few days to weeks to come back, and interpretation of these results in presence of hemodialysis could be challenging. Our patient didn’t have constipation, as there have been reported cases of hyperammonemia secondary to the microbial proliferation of urease-producing bacteria such as Proteus species and he did not have a history of taking drugs that could have been a potential cause of his hyperammonemia [ 10 ]. Although his liver function was not optimal during the initial days of chemotherapy, it had improved after the hyperammonemia had been detected and treated.…”