Matson Kristine M, Sonetti David A
Division of Infectious Disease, Department of Internal Medicine, University of Wisconsin Hospital and Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Division of Allergy, Pulmonary, and Critical Care, Department of Internal Medicine, University of Wisconsin Hospital and Clinics, University of Wisconsin School of Medicine-Madison School of Medicine and Public Health, Madison, Wisconsin.
Transpl Infect Dis. 2019 Feb;21(1):e13022. doi: 10.1111/tid.13022. Epub 2018 Nov 22.
Hyperammonemia, in the absence of significant liver dysfunction, is an uncommon but often fatal occurrence following orthotopic lung transplant. Prior reports have provided evidence to support Ureaplasma species as an etiology for this syndrome. This case report describes an individual post-lung transplant, treated emperically with doxycycline along with other measures to lower ammonia levels, at the time hyperammonemia with encephalopathy was recognized. The patient clinically improved. Ureaplasma species were subsequently identified using 16S ribosomal RNA gene PCR/sequencing of pleural fluid, and by culture of bronchoalveolar (BAL) fluid. This case provides further support for empiric treatment of Ureaplasma species upon recognition of hyperammonemia syndrome post-lung transplant.
在没有明显肝功能障碍的情况下，高氨血症是原位肺移植后一种罕见但往往致命的情况。先前的报告已提供证据支持脲原体属作为该综合征的病因。本病例报告描述了一名肺移植后的患者，在识别出伴有脑病的高氨血症时，经验性地使用强力霉素以及其他降低氨水平的措施进行治疗。患者临床症状改善。随后通过对胸腔积液进行16S核糖体RNA基因PCR/测序以及对支气管肺泡灌洗液进行培养，鉴定出脲原体属。该病例为肺移植后识别出高氨血症综合征时对脲原体属进行经验性治疗提供了进一步支持。
