title: Idiopathic Hyperammonemia That Developed During Initial Treatment With Steroid in a Patient With Newly Diagnosed Leukemia.
abstract: Idiopathic hyperammonemia (IHA) has been described as a complication of intensive chemotherapy for the treatment of hematologic malignancy but has subsequently been found in patients undergoing bone marrow transplantation and in those with solid tumors treated with 5-fluorouracil. Although IHA is a rare complication, it is sometimes associated with high mortality in hematologic malignancies. Here we report the case of a 15-year-old boy in whom hyperammonemia developed during the initial treatment with prednisolone for newly diagnosed acute lymphoblastic leukemia and who survived after early detection and oral lactulose therapy. To the best of our knowledge, this is the first report of IHA that was not induced by intensive chemotherapy, stem cell transplantation, or asparaginase therapy in a patient with newly diagnosed leukemia, but developed during an initial treatment with a steroid. Early detection of IHA by measuring the plasma ammonia level in patients with neurological symptoms may improve the outcome.
authors.affiliation: Departments of *Pediatrics †Pediatric Oncology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.forename: Hideki
authors.initials: H
authors.lastname: Sano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Akaihata
authors.forename: Tomoko
authors.initials: T
authors.lastname: Waragai
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ohara
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Hosoya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuta
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003561:Cytarabine / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D022124:Hyperammonemia / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D007792:Lactulose / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis
chemical_list: D003561:Cytarabine; D007792:Lactulose; D011239:Prednisolone; D006854:Hydrocortisone; D008727:Methotrexate