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Hyperammonemia, an under-recognized complication and adverse prognostic marker in Multiple Myeloma

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Chojecki A. L., Gharibo M., Styler M. J.
Cell death in therapy
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2014
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vol. 1
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issue 1
EN
Hyperammonemia, a well-known complication of liver failure causing encephalopathy, has rarely been reported as a complication of multiple myeloma. We report four additional cases of hyperammonemia in patients with treatment refractory multiple myeloma. In these cases, we found that hyperammonemia remains a morbid complication of resistant disease without directed myeloma therapy. Our brief review has reaffirmed that hyperammonemia is a poor prognostic marker in myeloma with an undetermined mechanism. This complication’s poor response to traditional therapies, including rifaximin and lactulose, prompts our discussion urging early recognition and myeloma directed therapy. Clinical observations may support that proteasome inhibitors may be most effective in the treatment of these patients.
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Hyperammonemia in a patient with obstructive urinary tract infection due to Corynebacterium urealyticum

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Kenzaka T., Kumabe A., Urushibara Y., Minami K., Ishida T.
Open Medicine
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2013
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vol. 8
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issue 5
597-599
EN
A 93-year-old woman with neurogenic bladder was admitted to our hospital because of impaired consciousness. Her urine culture revealed urease-test-positive Corynebacterium urealyticum. She was diagnosed with hyperammonemia due to an obstructive urinary tract infection that was caused by urease-producing bacteria. The patient showed rapid improvement of impaired consciousness and hyperammonemia after urine analysis. It is necessary to consider obstructive urinary tract infection as a differential diagnosis of hyperammonemia, which commonly occurs in urinary tract infections owing to the presence of urease-producing bacteria. Relief from obstruction is the most important treatment for hyperammonemia caused by this mechanism.
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