Hyperammonemic encephalopathy with septic shock caused by obstructive urinary tract infection

Area of Science:

• Nephrology
• Infectious Diseases
• Critical Care Medicine

Background:

• Elevated ammonia levels can indicate severe metabolic disturbances.
• Urinary tract infections (UTIs) can lead to systemic complications like sepsis.
• Proteus mirabilis is a common pathogen in complicated UTIs.

Purpose of the Study:

• To report a case of severe obstructive UTI with Proteus mirabilis leading to hyperammonemia and septic shock.
• To highlight the importance of identifying and treating urinary tract obstruction in patients with altered mental status and sepsis.

Main Methods:

• Case report of a 61-year-old woman presenting with anuria, fever, and altered mental status.
• Diagnostic workup included blood tests (ammonia levels), abdominal CT scan, and microbial cultures (blood, urine, catheter clot).
• Treatment involved addressing the urinary obstruction and administering antibiotics.

Main Results:

• The patient presented with bilateral hydronephrosis, bladder fullness, and an obstructed urinary catheter due to a blood clot.
• Blood and urine cultures identified Proteus mirabilis.
• The patient was diagnosed with obstructive UTI complicated by septic shock and hyperammonemia (176 μg/dL).
• Following treatment, the patient's condition improved, and ammonia levels normalized.

Conclusions:

• Proteus mirabilis can cause severe obstructive urinary tract infections leading to life-threatening conditions such as septic shock and hyperammonemia.
• Timely diagnosis and management of urinary obstruction and infection are crucial for patient recovery.
• This case underscores the potential link between urinary tract infections and metabolic derangements like hyperammonemia.