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Hyperammonemic Encephalopathy Secondary to Urinary Tract Infection.

Asher Gorantla¹, Anandita Kishore², Areeba Zaman³

¹Internal Medicine, State University of New York Downstate Health Science Center, Brooklyn, USA.

|December 26, 2022

Summary

This case report highlights a rare cause of hyperammonemic encephalopathy (HE) in a 69-year-old man. Obstructive urinary tract infections from urease-producing bacteria can lead to HE, which is treatable with antibiotics and lactulose.

Keywords:

ammonia encephalopathy hyperammonemia urease-producing bacteria urinary tract infection

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Area of Science:

Nephrology
Neurology
Infectious Diseases

Background:

Hyperammonemic encephalopathy (HE) is a severe neurological condition characterized by elevated ammonia levels and altered mental status.
While liver disease is the most common cause, non-hepatic etiologies are rare and diagnostically challenging.

Observation:

A 69-year-old male experienced two episodes of altered mental status (AMS) associated with obstructive uropathy.
These episodes correlated with markedly elevated plasma ammonia levels.

Findings:

The patient's AMS and hyperammonemia resolved with antibiotic treatment for the urinary tract infection and lactulose administration.
Urease-producing bacteria in the context of obstructive uropathy were identified as the cause of HE.

Implications:

This case underscores the importance of considering non-hepatic causes of HE, specifically obstructive uropathy due to urease-producing bacteria.
Early recognition and treatment of this potentially fatal condition can prevent complications like intractable coma and mortality.