Pandey Sagar, Tun Myo Myint, Htet Shwe Yee, Chhetri Bhawana, K C Nabin
Internal Medicine, One Brooklyn Health/ Interfaith Medical Center, Brooklyn, USA.
Internal Medicine, Nepal Medical College Teaching Hospital, Kathmandu, NPL.
Cureus. 2023 May 27;15(5):e39579. doi: 10.7759/cureus.39579. eCollection 2023 May.
Hyperammonemic encephalopathy (HE) can be broadly defined as an alteration in the level of consciousness due to elevated blood ammonia level. While hepatic cirrhosis is the most common cause of HE, non-hepatic causes like drugs, infections, and porto-systemic shunts can also lead to the presentation. In this case, we highlight an unusual occurrence of recurrent non-cirrhotic HE from obstructive urinary tract infection (UTI) with urea-splitting micro-organisms in an elderly male patient. The patient exhibited altered mentation, and elevated ammonia levels with normal hepatic function at presentation. Urine culture revealed Proteus mirabilis resistant to extended spectrum beta-lactamases (ESBL). Successful management of obstructive UTI was achieved through Foley's catheterization and intravenous (IV) antibiotics, resulting in the resolution of HE. This outcome further supports the significance of UTI as a potential cause of hyperammonemia. Thus, UTI as one of the non-hepatic causes of hyperammonemia should always be explored among elderly patients presenting with altered mentation.
高氨血症性脑病（HE）可广义定义为因血氨水平升高导致的意识水平改变。虽然肝硬化是HE最常见的病因，但药物、感染和门体分流等非肝脏病因也可导致该病的发生。在此病例中，我们着重介绍了一名老年男性患者因梗阻性尿路感染（UTI）伴尿素分解微生物而反复发生非肝硬化性HE的罕见情况。患者就诊时表现为精神状态改变，氨水平升高而肝功能正常。尿培养显示奇异变形杆菌对超广谱β-内酰胺酶（ESBL）耐药。通过留置导尿管和静脉注射抗生素成功治疗了梗阻性UTI，HE得以缓解。这一结果进一步支持了UTI作为高氨血症潜在病因的重要性。因此，在出现精神状态改变的老年患者中，应始终探究UTI作为高氨血症非肝脏病因之一的可能性。
