{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:43:05Z","timestamp":1786977785822,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunity Inflam &amp;amp; Disease"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although primarily reported in solid organ transplant recipients and patients undergoing chimeric antigen receptor T\u2010cell immunotherapy (CAR\u2010T), non\u2010hepatic hyperammonemia (NHHA) is a rare but lethal complication in the broader context of post\u2010 chemo\u2010immunotherapy hematologic malignancies. It often presents with unexplained encephalopathy that mimics primary central nervous system (CNS) progression, leading to diagnostic delays. With the expanding use of bispecific antibodies (e.g., glofitamab), the etiology of NHHA, particularly the complex interplay between opportunistic infections and potential metabolic susceptibility, remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      We report a fatal case of NHHA in a 58\u2010year\u2010old male with diffuse large B\u2010cell lymphoma (DLBCL) following glofitamab\u2010based chemo\u2010immunotherapy. The patient developed sudden onset altered mental status with extreme hyperammonemia (peak blood ammonia 638.9\u2009\u00b5mol\/L) despite preserved liver function. Metagenomic next\u2010generation sequencing (mNGS) of bronchoalveolar lavage fluid identified\n                      <jats:italic>Ureaplasma urealyticum<\/jats:italic>\n                      . Furthermore, post\u2010mortem whole\u2010exome sequencing (WES) identified a heterozygous variant of SLC25A13 (NM_014251.3:c.2\u2009T\u2009&gt;\u2009C). As biochemical confirmation of citrin deficiency was not available, the clinical significance of this variant remains uncertain, though it may represent a contributory metabolic susceptibility factor. Despite aggressive ammonia\u2010lowering strategies, including continuous renal replacement therapy (CRRT) and targeted antibiotics, the patient succumbed to fulminant cerebral edema.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case highlights the\n                      <jats:italic>Ureaplasma urealyticum<\/jats:italic>\n                      infection as a critical precipitant of fatal NHHA following glofitamab therapy, occurring in the background of possible genetic metabolic susceptibility (an unverified heterozygous SLC25A13 variant of uncertain functional significance). These findings underscore the critical need for early blood ammonia monitoring and rapid mNGS screening in immunocompromised patients with unexplained encephalopathy. We propose a structured diagnostic algorithm to expedite the recognition and management of this reversible yet life\u2010threatening condition.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/iid3.70443","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T06:32:10Z","timestamp":1776753130000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fatal Non\u2010Hepatic Hyperammonemia Post\u2010Glofitamab:\n                    <i>Ureaplasma<\/i>\n                    and Genetic Susceptibility: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"given":"Yinshan","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuliu","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoling","family":"Wang","sequence":"additional","affiliation":[{"name":"Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0478-7491","authenticated-orcid":false,"given":"Feng","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University Hangzhou Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2478\/jtim-2022-0021"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.589825"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000206778"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2022.154042"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2023.154456"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.684040"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf084"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-242513"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000828"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac748"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom10040655"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-00797-y"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14334"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17152426"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-317"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2022.01.036"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad263"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20056"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-020-00959-7"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1570"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14132755"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2022.10433"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0707353"}],"container-title":["Immunity, Inflammation and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/iid3.70443","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/iid3.70443","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/iid3.70443","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T03:56:53Z","timestamp":1777435013000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/iid3.70443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/iid3.70443"],"URL":"https:\/\/doi.org\/10.1002\/iid3.70443","archive":["Portico"],"relation":{},"ISSN":["2050-4527","2050-4527"],"issn-type":[{"value":"2050-4527","type":"print"},{"value":"2050-4527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-01-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70443"}}