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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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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 |
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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 |
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