Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Infective hyperammonaemic encephalopathy after allogeneic stem cell transplant

Bone Marrow Transplantation volume 57, pages 1028–1030 (2022)Cite this article

Subjects

Access through your institution
Buy or subscribe

Currently allogeneic haematopoietic stem cell transplantation (AlloHSCT) is the only curative therapy for primary myelofibrosis (PMF), but the inherent risks include a transplant-related mortality of 20%. Ultimately 20% of patients die from infection secondary to ongoing immunosuppression and potentially due to a greater incidence of poor graft function and failure [1].

A 65-year-old female with high-risk PMF (Dynamic International Prognostic Scoring System of 5) underwent a Fludarabine 25 mg/m2, Melphalan 140 mg/m2 and rabbit antithymocyte globulin (rATG)-conditioned matched unrelated donor AlloHSCT. She was treated previously with hydroxyurea, anagrelide and ruxolitinib. Comorbidities included gastro-oesophageal reflux disease and depression. She was an ex-smoker with a mildly reduced diffusing capacity. Consequently, her Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) was 3, with a high risk of non-relapse mortality. Graft-versus-host disease prophylaxis included ciclosporin, methotrexate and rATG. Antimicrobial prophylaxis comprised posaconazole 300 mg orally daily and aciclovir 250 mg IV three times daily.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Robin M, de Wreede LC, Wolschke C, Schetelig J, Eikema D, Van Lint MT. et al. Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis. Haematologica. 2019;104:1782–8. https://doi.org/10.3324/haematol.2018.205211.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Oeser C, Pond M, Butcher P, Bedford-Russell A, Henneke P, Laing K. et al. PCR for the detection of pathogens in neonatal early onset sepsis. PLoS ONE. 2020;15:e0226817. https://doi.org/10.1371/journal.pone.0226817.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. McCormack WM, Rosner B, Lee Y-H. Colonization with genital mycoplasmas in women. Am J Epidemiol. 1973;97:240–5. https://doi.org/10.1093/oxfordjournals.aje.a121505.

    Article  CAS  PubMed  Google Scholar 

  4. Leger RF, Silverman MS, Hauck ES, Guvakova KD. Hyperammonemia post lung transplantation: a review. Clin Med Insights Circ Respir Pulm Med. 2020;14:1179548420966234. https://doi.org/10.1177/1179548420966234.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bharat A, Cunningham SA, Scott Budinger GR, Kreisel D, DeWet CJ, Gelman AE. et al. Disseminated Ureaplasma infection as a cause of fatal hyperammonemia in humans. Sci Transl Med. 2015;7:284re3. https://doi.org/10.1126/scitranslmed.aaa8419.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Smibert OC, Wilson HL, Sohail A, Narayanasamy S, Schultz MB, Ballard SA. et al. Donor-derived mycoplasma hominis and an apparent cluster of M. hominis cases in solid organ transplant recipients. Clin Infect Dis. 2017;65:1504–8. https://doi.org/10.1093/cid/cix601.

    Article  CAS  PubMed  Google Scholar 

  7. Davies SM, Szabo E, Wagner JE, Ramsay NK, Weisdorf DJ. Idiopathic hyperammonemia: a frequently lethal complication of bone marrow transplantation. Bone Marrow Transpl. 1996;17:1119–25.

    CAS  Google Scholar 

  8. Graetz R, Meyer R, Shehab K, Katsanis E. Successful resolution of hyperammonemia following hematopoietic cell transplantation with directed treatment of Ureaplasma parvum infection. Transpl Infect Dis. 2018;20:e12839. https://doi.org/10.1111/tid.12839.

    Article  PubMed  Google Scholar 

  9. Tawfik P, Arndt P. Lethal hyperammonemia in a CAR-T cell recipient due to Ureaplasma pneumonia: a case report of a unique severe complication. BMJ Case Rep. 2021;14:e242513. https://doi.org/10.1136/bcr-2021-242513.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sumransub N, He F, Weisdorf D, Billington CJ, Aggarwal A, Miller B. et al. Severe hyperammonemia in chimeric antigen receptor T cells recipient—unusual differential diagnosis of encephalopathy syndrome. Bone Marrow Transpl. 2022;57:286–8. https://doi.org/10.1038/s41409-021-01505-5.

    Article  CAS  Google Scholar 

  11. Kurihara C, Manerikar A, Kandula V, Cerier E, Bharat A. Prophylactic ureaplasma-directed antimicrobials in lung donors can prevent fatal hyperammonemia. Transplantation. 2021;105. https://doi.org/10.1097/TP.0000000000003540.

  12. Waites KB, Taylor-Robinson D. Mycoplasma and Ureaplasma. 12th ed. Washington DC: ASM Press; 2019.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia

    Michael J. Shipton, Thomas Davis, Jeff Szer & David Routledge

  2. Department of Microbiology, Royal Melbourne Hospital, Melbourne, VIC, Australia

    Paul M. Kinsella

  3. Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia

    Francesca Azzato

  4. Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia

    George Taiaroa

  5. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Olivia Smibert

  6. Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia

    Olivia Smibert

Authors
  1. Michael J. Shipton
    View author publications

    Search author on:PubMed Google Scholar

  2. Paul M. Kinsella
    View author publications

    Search author on:PubMed Google Scholar

  3. Thomas Davis
    View author publications

    Search author on:PubMed Google Scholar

  4. Francesca Azzato
    View author publications

    Search author on:PubMed Google Scholar

  5. George Taiaroa
    View author publications

    Search author on:PubMed Google Scholar

  6. Jeff Szer
    View author publications

    Search author on:PubMed Google Scholar

  7. David Routledge
    View author publications

    Search author on:PubMed Google Scholar

  8. Olivia Smibert
    View author publications

    Search author on:PubMed Google Scholar

Contributions

MJS, PMK and TD wrote the manuscript. FA and GT performed laboratory analysis. JS, DR and OS provided feedback on the report. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olivia Smibert.

Ethics declarations

Competing interests

JS has received funding for consulting fees from Takeda and Alexion; has received honoraria from Takeda, Alexion and Pfizer; and is on an advisory board for Prevail Therapeutics and Novartis. DR has received honoraria from Amgen, BMS, Pfizer, Janssen and Sandoz; and financial support for attending meetings from Amgen and BMS. All others authors report no conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Consent for publication

The patient’s next of kin provided informed consent for the publication of this case presentation.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shipton, M.J., Kinsella, P.M., Davis, T. et al. Infective hyperammonaemic encephalopathy after allogeneic stem cell transplant. Bone Marrow Transplant 57, 1028–1030 (2022). https://doi.org/10.1038/s41409-022-01669-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41409-022-01669-8

This article is cited by

Search

Advanced search

Quick links