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[Empyema thoracis accompanied by hyperammonemic encephalopathy].

N Kuze1, Y Nishizaka, K Okamoto

  • 1Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan.

Nihon Kokyuki Gakkai Zasshi = the Journal of the Japanese Respiratory Society
|April 25, 2000
PubMed
Summary

A patient with altered consciousness had severe hyperammonemia due to a pleural space infection with urease-producing anaerobes. Treatment with antibiotics and pleural drainage improved neurological status and ammonia levels.

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Pulmonology

Background:

  • Consciousness disturbance can stem from various underlying conditions, including metabolic encephalopathies.
  • Hyperammonemia, a condition of elevated ammonia levels, is a known cause of altered mental status.
  • Pleural effusions are typically associated with respiratory or systemic illnesses, rarely with neurological compromise.

Observation:

  • A 50-year-old male presented with coma and normal brain CT, but massive right-sided pleural effusion.
  • Purulent pleural fluid culture identified urease-producing anaerobes, including Bacteroides fragilis.
  • Markedly elevated serum ammonia (586 µg/dL), white blood cell count, and C-reactive protein were noted, with preserved liver function.

Findings:

  • The patient's consciousness improved following antibiotic therapy and pleural drainage.

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  • Neurological recovery correlated with decreasing serum ammonia and C-reactive protein levels.
  • The absence of other metabolic derangements pointed to the pleural infection as the source of hyperammonemia.

    • Implications:

    • This case highlights a rare cause of hyperammonemic encephalopathy originating from a localized anaerobic pleural infection.
    • It underscores the importance of considering non-hepatic causes of hyperammonemia in patients with altered consciousness and infection.
    • Prompt diagnosis and management of pleural infections are crucial to prevent severe neurological complications.