Paparoupa Maria, Barten Markus Johannes, de Heer Jocelyn, Giessen Hanna Sophie, Frings Daniel, Kluge Stefan
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.
University Heart & Vascular Center Hamburg, Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.
Respir Med Case Rep. 2020 May 6;30:101080. doi: 10.1016/j.rmcr.2020.101080. eCollection 2020.
Ureaplasma urealyticum is a commensal of the female genital tract and can be detected as a pathogen in urethritis and vaginitis. Its importance as a respiratory pathogen beyond the field of neonatology remains controversial. We report a case of Ureaplasma-pneumonia in a recently lung-transplanted patient, with hyperammonemic syndrome. The 51-year-old lung-transplanted female was admitted to the intensive care unit with new-onset reduction of her mental state due to hyperammonemia. A diagnostic bronchoscopy showed purulent bronchitis and multiple superficial ulcerations of the bronchial mucosa. The DNA-PCR from bronchoalveolar lavage confirmed the presence of Ureaplasma urealyticum in low concentration (about 5 * 10 copies/ml), which was interpreted as evidence of infection and treated with Doxycycline intravenously. Ureaplasma was also identified by DNA-PCR in the biopsy specimens of the inflammatory enlarged mediastinal lymph nodes. Bilateral pleural effusions were found to be transudative and culturally sterile. Ureaplasma-pneumonia can cause fatal hyperammonemia in lung-transplant patients and should be considered in the differential diagnosis of every unclear hyperammonemia with normal liver function. The early identification and treatment of the infection leads to clinical and biochemical resolution.
解脲脲原体是女性生殖道的共生菌，在尿道炎和阴道炎中可被检测为病原体。其作为新生儿科以外的呼吸道病原体的重要性仍存在争议。我们报告了一例近期肺移植患者发生的解脲脲原体肺炎，并伴有高氨血症综合征。这位51岁的肺移植女性因高氨血症导致精神状态新发减退而入住重症监护病房。诊断性支气管镜检查显示为脓性支气管炎和支气管黏膜多处浅表溃疡。支气管肺泡灌洗的DNA-PCR证实存在低浓度（约5×10拷贝/ml）的解脲脲原体，这被解释为感染证据，并给予静脉注射多西环素治疗。在炎症性肿大的纵隔淋巴结活检标本中，通过DNA-PCR也鉴定出了解脲脲原体。发现双侧胸腔积液为漏出液，培养无菌。解脲脲原体肺炎可导致肺移植患者发生致命的高氨血症，在肝功能正常的不明原因高氨血症的鉴别诊断中应予以考虑。感染的早期识别和治疗可使临床和生化指标恢复正常。
