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Hyperammonemia by Ureaplasma urealyticum Pneumonia after Lung Transplantation.
Respir Med Case Rep. 2020; 30:101080.RM

Abstract

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 * 104 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.

Authors+Show Affiliations

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.Department of Internal Medicine, Gastroenterology, Infectiology and Tropical Diseases, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, D-20246, Hamburg, Germany.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32420020

Citation

Paparoupa, Maria, et al. "Hyperammonemia By Ureaplasma Urealyticum Pneumonia After Lung Transplantation." Respiratory Medicine Case Reports, vol. 30, 2020, p. 101080.
Paparoupa M, Barten MJ, de Heer J, et al. Hyperammonemia by Ureaplasma urealyticum Pneumonia after Lung Transplantation. Respir Med Case Rep. 2020;30:101080.
Paparoupa, M., Barten, M. J., de Heer, J., Giessen, H. S., Frings, D., & Kluge, S. (2020). Hyperammonemia by Ureaplasma urealyticum Pneumonia after Lung Transplantation. Respiratory Medicine Case Reports, 30, 101080. https://doi.org/10.1016/j.rmcr.2020.101080
Paparoupa M, et al. Hyperammonemia By Ureaplasma Urealyticum Pneumonia After Lung Transplantation. Respir Med Case Rep. 2020;30:101080. PubMed PMID: 32420020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperammonemia by Ureaplasma urealyticum Pneumonia after Lung Transplantation. AU - Paparoupa,Maria, AU - Barten,Markus Johannes, AU - de Heer,Jocelyn, AU - Giessen,Hanna Sophie, AU - Frings,Daniel, AU - Kluge,Stefan, Y1 - 2020/05/06/ PY - 2019/10/30/received PY - 2020/05/05/accepted PY - 2020/5/19/entrez PY - 2020/5/19/pubmed PY - 2020/5/19/medline KW - Atypical pneumonia KW - Hyperammonemic syndrome KW - Immunosuppression SP - 101080 EP - 101080 JF - Respiratory medicine case reports JO - Respir Med Case Rep VL - 30 N2 - 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 * 104 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. SN - 2213-0071 UR - https://www.unboundmedicine.com/medline/citation/32420020/Hyperammonemia_by_Ureaplasma_urealyticum_Pneumonia_after_Lung_Transplantation L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-0071(19)30339-9 DB - PRIME DP - Unbound Medicine ER -
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