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A Case of Infectious Enterocolitis with Hyperammonemia
Ken Otsuji1,2, Satoko Simizu1, Takeru Endo1
1Intensive Care Unit, Hospital of University of Occupational and Environmental Health, Japan.
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.
Insights
Acute hyperammonemia can occur with infectious enterocolitis, not just urinary tract infections. Urease-producing bacteria are suspected culprits, even if not identified by cultures.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Nephrology
Background:
- Hyperammonemia is occasionally linked to urease-producing bacteria, typically in urinary tract infections.
- This case explores a rare instance of hyperammonemia in infectious enterocolitis.
Observation:
- A Japanese woman in her 70s with microscopic polyangiitis developed severe hyperammonemia and coma during infectious enterocolitis.
- Her condition improved with antibiotics and ammonia detoxification, ruling out other common causes.
Findings:
- Despite negative cultures for urease-producing bacteria, the clinical presentation strongly suggested their involvement in the hyperammonemia.
- This highlights a potential, yet unidentified, bacterial source in the gastrointestinal tract.
Implications:
- Clinicians should consider urease-producing bacteria as a cause of acute hyperammonemia in infectious enterocolitis.
- Further research is needed to identify specific urease-producing bacteria involved in gastrointestinal infections and hyperammonemia.
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