RESUMO
Idiopathic hyperammonemia is a rare, poorly understood, and often lethal condition that has been described in immunocompromised patients. This report describes an immunocompromised patient with acute myelogenous leukemia who developed persistent hyperammonemia up to 705 µmol/L (normal, 0 to 47 µmol/L) refractory to multiple different therapies. However, after beginning azithromycin and then doxycycline therapy for Ureaplasma species infection, the patient showed immediate and sustained clinical improvement and resolution of ammonia levels. Recognizing disseminated Ureaplasma species infection as a potential cause of idiopathic hyperammonemia, an unexplained, often fatal condition in immunocompromised patients, and empirically treating for this infection could potentially be lifesaving.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hiperamonemia/etiologia , Hospedeiro Imunocomprometido/efeitos dos fármacos , Quimioterapia de Indução/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Infecções por Ureaplasma/complicações , Ureaplasma/efeitos dos fármacos , Adolescente , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Feminino , Humanos , Hiperamonemia/tratamento farmacológico , Hiperamonemia/patologia , Leucemia Mieloide Aguda/microbiologia , Leucemia Mieloide Aguda/patologia , Prognóstico , Infecções por Ureaplasma/induzido quimicamente , Infecções por Ureaplasma/microbiologiaRESUMO
UNLABELLED: Neonatal hyperkalemia and hyponatremia are medical conditions that require an emergent diagnosis and treatment to avoid morbidity and mortality. Here, we describe the case of a 10-day-old female baby presenting with life-threatening hyperkalemia, hyponatremia, and metabolic acidosis diagnosed as autosomal dominant pseudohypoaldosteronism type 1 (PHA1). This report aims to recognize that PHA1 may present with a life-threatening arrhythmia due to severe hyperkalemia and describes the management of such cases in neonates. LEARNING POINTS: PHA1 may present with a life-threatening arrhythmia.Presentation of PHA can be confused with congenital adrenal hyperplasia.Timing and appropriate medical management in the critical care unit prevented fatality from severe neonatal PHA.