Successful management of noncirrhotic hyperammonemia syndrome after kidney transplantation from putative Ureaplasma infection

Noncirrhotic hyperammonemia (NCH) is a rare but often fatal complication of solid organ transplantation. We present a case wherein an infectious cause of NCH was suspected following kidney transplantation (KT) and the patient was promptly started on empirical antibiotic treatment which proved to be lifesaving. A 56‐year‐old Chinese woman with a past medical history of end‐stage renal disease secondary to ischemic nephropathy and cerebrovascular accident received a kidney from a 52‐year‐old brain‐dead donor with a Kidney Donor Profile Index score of 70%. She experienced immediate graft function and was discharged on post‐operative day (POD) 4. On POD 10, she presented with a fever, acute onset of confusion, and abdominal pain. Her mental status deteriorated and required emergent intubation. Empiric broad‐spectrum antibiotics were initiated. On hospital day 3, a serum ammonia was 889 μmol/L (normal