Hyperammonemic encephalopathy due to urinary tract infection by urea splitting bacteria. A pediatric case report

• Published in: Archivos argentinos de pediatría Vol. 115; no. 6; pp. e454 - e457
• Main Authors: Acosta, Pamela, Nogueira, Manuel, Gallagher, Rosario, Waquim, Cecilia, Piroli, Ignacio, Carmona, Rodrigo, Centeno, Mónica, Motto, Eduardo
• Format: Journal Article
• Language: Spanish
• Published: Argentina 01-12-2017
• Subjects: Brain Diseases, Metabolic - etiology; Child, Preschool; Corynebacterium Infections - complications; Corynebacterium Infections - metabolism; Humans; Hyperammonemia - etiology; Male; Urea - metabolism; Urinary Tract Infections - complications; Urinary Tract Infections - microbiology; hyperammonemia; urea-splitting bacteria; encephalopathy; pediatrics
• ISSN: 1668-3501
• DOI: 10.5546/aap.2017.e454

Elevated level of ammonia in the blood, defined as hyperammonemia, is feasible to cause neurological symptoms when crossing the blood-brain barrier. The most frequent and studied cause of hyperammonemia is liver failure. Nevertheless, other less frequent and known etiologies must be considered. Urinary tract infection caused by urea-splitting bacteria, despite being unusual in pediatric patients, must be taken into account. We report a pediatric patient with severe acute encephalopathy and high levels of ammonia in blood. After ruling out other causes of hyperammonemia, it was assumed secondary to urinary tract infection by Corynebacterium riegelii, a ureasplitting bacteria. General treatment for hyperammonemic encephalopathy was established, as well as specific treatment with antibiotics. The patient evolved favorably.