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Related Experiment Video

Updated: Aug 10, 2025

Multimodal Bioluminescent and Positronic-emission Tomography/Computational Tomography Imaging of Multiple Myeloma Bone Marrow Xenografts in NOG Mice
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Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report.

Ilma Vahora1, Ezhil Panneerselvam2, Abhizith Deoker1

  • 1Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.

Cureus
|February 15, 2023
PubMed
Summary

Hyperammonemic encephalopathy (HE) is a rare complication of multiple myeloma (MM). This case highlights the importance of considering HE in MM patients with altered mental status, even when other causes are treated.

Keywords:
altered mental statusammoniacyclophosphamidehyperammonemic encephalopathymultiple myeloma

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Area of Science:

  • Neurology
  • Hematology
  • Oncology

Background:

  • Multiple myeloma (MM) commonly manifests with bone lesions, hypercalcemia, anemia, and renal failure.
  • Hyperammonemic encephalopathy (HE) is an infrequent complication of MM, often overlooked due to a broad differential diagnosis for altered mental status (AMS).

Observation:

  • A 68-year-old female with MM presented with AMS and elevated ammonia levels, diagnosed with HE.
  • The patient's condition worsened despite treatment for infection, necessitating intubation.
  • Myeloma cell lines were implicated in elevated ammonia levels, independent of liver disease.

Findings:

  • HE in MM is linked to increased ammonia production by myeloma cells.
  • Standard AMS treatments were insufficient, underscoring the need for specific HE management.
  • Chemotherapy was not an option due to the patient's pancytopenia and infection.

Implications:

  • Clinicians should consider HE in MM patients with AMS, especially when common causes are addressed without improvement.
  • Early recognition and targeted treatment of HE are crucial for improving outcomes in multiple myeloma patients.
  • This case emphasizes the need for increased awareness of HE as a treatable cause of AMS in the context of multiple myeloma.