PDF(Pubmed)
Abstract：
Hyperammonemia syndrome has a high mortality rate in the immunosuppressed population due to its association with mental status changes. Recently studies have shown that Ureaplasma organisms\' infection can lead to hyperammonemia in post-transplant patients. Symptoms typically occur within 30 days postoperatively. However, the late-onset hyperammonemia caused by Ureaplasma parvum infection after kidney transplantation has never been reported. In this case study, a 64-year-old Chinese male presented with symptoms such as nausea, vomiting, trouble sleeping, and deteriorating mental status 81 days after kidney transplantation. His plasma ammonia level was significantly elevated, and there was no evidence of liver synthetic dysfunction. Although common methods for ammonia clearance, such as haemodialysis and oral lactulose were initiated, his serum ammonia levels remained high. Metagenomic sequencing of serum determined Ureaplasma parvum infection. Levofloxacin and minocycline were administered respectively, which resulted in a decrease in ammonia levels, but normalization was not achieved. The computed tomographic scan revealed the presence of cerebral edema. Unfortunately, the patient eventually became brain dead with multiple organ failure. This case highlights that Ureaplasma parvum can cause late-onset hyperammonemia in kidney transplant patients. Once the mental status changes are identified, immediate empiric treatments should be initiated without waiting for a confirmed diagnosis of Ureaplasma spp. infection.
摘要：
高氨血症综合征由于与精神状态变化有关，在免疫抑制人群中死亡率很高。最近的研究表明，脲原体感染可导致移植后患者的高氨血症。症状通常发生在术后30天内。然而,肾移植后由细小脲原体感染引起的迟发性高氨血症从未有报道.在这个案例研究中,一名64岁的中国男性出现恶心等症状，呕吐,睡眠困难，肾移植术后81天精神状态恶化。他的血浆氨水平明显升高，也没有肝脏合成功能障碍的证据.虽然常用的氨清除方法，如血液透析和口服乳果糖，他的血清氨水平仍然很高。血清宏基因组测序确定细小脲原体感染。分别给予左氧氟沙星和米诺环素,导致氨含量下降，但没有实现正常化。计算机断层扫描显示存在脑水肿。不幸的是,患者最终因多器官衰竭而脑死亡。此病例突出表明，细小脲原体可引起肾移植患者的迟发性高氨血症。一旦精神状态的变化被识别，应立即开始经验性治疗，而无需等待明确的脲原体诊断。感染。
