Cargando…

Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report

Multiple myeloma (MM) typically presents as lytic bony lesions, hypercalcemia, anemia, and renal failure. Only a few cases of hyperammonemic encephalopathy (HE) attributed to multiple myeloma have been reported. We report a case of a 68-year-old Hispanic female diagnosed with multiple myeloma and pr...

Descripción completa

Detalles Bibliográficos
Autores principales: Vahora, Ilma, Panneerselvam, Ezhil, Deoker, Abhizith
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911933/
https://www.ncbi.nlm.nih.gov/pubmed/36788901
http://dx.doi.org/10.7759/cureus.33626
_version_ 1784885101318897664
author Vahora, Ilma
Panneerselvam, Ezhil
Deoker, Abhizith
author_facet Vahora, Ilma
Panneerselvam, Ezhil
Deoker, Abhizith
author_sort Vahora, Ilma
collection PubMed
description Multiple myeloma (MM) typically presents as lytic bony lesions, hypercalcemia, anemia, and renal failure. Only a few cases of hyperammonemic encephalopathy (HE) attributed to multiple myeloma have been reported. We report a case of a 68-year-old Hispanic female diagnosed with multiple myeloma and presented with altered mental status and elevated ammonia levels found to have HE. The pathology behind HE is associated with higher ammonia levels produced by myeloma cell lines in the absence of liver disease. Due to the wide range of differentials for altered mental status (AMS), HE often gets missed and causes delayed treatment and the associated higher mortality. The primary treatment is chemotherapy. Lactulose and rifaximin must be initiated; however, it is ineffective if solely used. In our case, chemotherapy was not considered a treatment option in light of the patient's pancytopenia and infection. Our case is unique, as despite adequately treating other commonly suspected causes of AMS such as infection, there was no expected improvement in the patient's clinical status noticed, eventually leading to intubation due to worsening AMS. Given the patient's history of multiple myeloma, non-compliance with chemotherapy before presentation, and elevated ammonia levels raised suspicion for HE. Clinicians are encouraged to acquaint themselves with HE as a differential for patients presenting with MM flare and AMS, specifically when other potential causes of AMS are ruled out and addressed.
format Online
Article
Text
id pubmed-9911933
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-99119332023-02-13 Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report Vahora, Ilma Panneerselvam, Ezhil Deoker, Abhizith Cureus Internal Medicine Multiple myeloma (MM) typically presents as lytic bony lesions, hypercalcemia, anemia, and renal failure. Only a few cases of hyperammonemic encephalopathy (HE) attributed to multiple myeloma have been reported. We report a case of a 68-year-old Hispanic female diagnosed with multiple myeloma and presented with altered mental status and elevated ammonia levels found to have HE. The pathology behind HE is associated with higher ammonia levels produced by myeloma cell lines in the absence of liver disease. Due to the wide range of differentials for altered mental status (AMS), HE often gets missed and causes delayed treatment and the associated higher mortality. The primary treatment is chemotherapy. Lactulose and rifaximin must be initiated; however, it is ineffective if solely used. In our case, chemotherapy was not considered a treatment option in light of the patient's pancytopenia and infection. Our case is unique, as despite adequately treating other commonly suspected causes of AMS such as infection, there was no expected improvement in the patient's clinical status noticed, eventually leading to intubation due to worsening AMS. Given the patient's history of multiple myeloma, non-compliance with chemotherapy before presentation, and elevated ammonia levels raised suspicion for HE. Clinicians are encouraged to acquaint themselves with HE as a differential for patients presenting with MM flare and AMS, specifically when other potential causes of AMS are ruled out and addressed. Cureus 2023-01-10 /pmc/articles/PMC9911933/ /pubmed/36788901 http://dx.doi.org/10.7759/cureus.33626 Text en Copyright © 2023, Vahora et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Vahora, Ilma
Panneerselvam, Ezhil
Deoker, Abhizith
Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title_full Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title_fullStr Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title_full_unstemmed Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title_short Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report
title_sort hyperammonemic encephalopathy in multiple myeloma: a case report
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911933/
https://www.ncbi.nlm.nih.gov/pubmed/36788901
http://dx.doi.org/10.7759/cureus.33626
work_keys_str_mv AT vahorailma hyperammonemicencephalopathyinmultiplemyelomaacasereport
AT panneerselvamezhil hyperammonemicencephalopathyinmultiplemyelomaacasereport
AT deokerabhizith hyperammonemicencephalopathyinmultiplemyelomaacasereport