{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:51:12Z","timestamp":1787241072282,"version":"build-2736575974"},"reference-count":26,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,11]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>\n                    We report the first incidence of\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    infection causing lethal hyperammonemia in a chimeric receptor antigen T cell (CAR-T) recipient. A 53-year-old woman, after receiving CAR-T therapy, suffered sepsis and encephalopathy. She was found to have hyperammonemia up to 643 \u00b5mol\/L. Imaging revealed lung consolidations and bronchoalveolar lavage PCR was positive for\n                    <jats:italic>U. parvum<\/jats:italic>\n                    . Workup excluded liver failure and metabolic abnormalities. Antibiotics, lactulose, dextrose, arginine, levocarnitine, sodium phenylbutyrate and dialysis were used. Despite these, the patient suffered persistent elevations in ammonia, status epilepticus and cerebral oedema. Early recognition of this rare infection in susceptible populations is needed. CAR-T patients are at risk due to their immunocompromised state and may have amplified harm due to the impact of CAR-T therapy on astrocytes. An early aggressive multimodality approach is needed given the high mortality rates. These include antimicrobials, possibly with double coverage for\n                    <jats:italic>Ureaplasma<\/jats:italic>\n                    . Additionally, concurrent ammonia-suppressing and ammonia-eliminating treatments are necessary.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2021-242513","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T05:27:10Z","timestamp":1625808430000},"page":"e242513","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Lethal hyperammonemia in a CAR-T cell recipient due to\n                    <i>Ureaplasma<\/i>\n                    pneumonia: a case report of a unique severe complication"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4693-9163","authenticated-orcid":false,"given":"Pierre","family":"Tawfik","sequence":"first","affiliation":[{"name":"Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Arndt","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"2025082703234718000_14.7.e242513.1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-017-0423-1"},{"key":"2025082703234718000_14.7.e242513.2","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1056\/NEJMoa1709919","article-title":"Long-Term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia","volume":"378","author":"Park","year":"2018","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082703234718000_14.7.e242513.3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s13045-018-0653-x","article-title":"Cytokine release syndrome: grading, modeling, and new therapy","volume":"11","author":"Liu","year":"2018","journal-title":"J Hematol Oncol"},{"key":"2025082703234718000_14.7.e242513.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.758"},{"key":"2025082703234718000_14.7.e242513.5","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/hon.2595","article-title":"Managing the toxicities of car T-cell therapy","volume":"37 Suppl 1","author":"Neelapu","year":"2019","journal-title":"Hematol Oncol"},{"key":"2025082703234718000_14.7.e242513.6","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz399","article-title":"Invasive Ureaplasma Infection in Patients Receiving Rituximab and Other Humoral Immunodeficiencies-A Case Report and Review of the Literature","volume":"6","author":"Jhaveri","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2025082703234718000_14.7.e242513.7","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1705346"},{"key":"2025082703234718000_14.7.e242513.8","doi-asserted-by":"crossref","DOI":"10.1111\/tid.13298","article-title":"Hyperammonemia syndrome due to Ureaplasma infection after liver-kidney transplant","volume":"22","author":"Cannon","year":"2020","journal-title":"Transpl Infect Dis"},{"key":"2025082703234718000_14.7.e242513.9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jcrc.2020.02.003","article-title":"Ureaplasma parvum causes hyperammonemia presenting as refractory status epilepticus after kidney transplant","volume":"57","author":"Legouy","year":"2020","journal-title":"J Crit Care"},{"key":"2025082703234718000_14.7.e242513.10","doi-asserted-by":"crossref","first-page":"117954842096623","DOI":"10.1177\/1179548420966234","article-title":"Hyperammonemia post lung transplantation: a review","volume":"14","author":"Leger","year":"2020","journal-title":"Clin Med Insights Circ Respir Pulm Med"},{"key":"2025082703234718000_14.7.e242513.11","first-page":"1119","article-title":"Idiopathic hyperammonemia: a frequently lethal complication of bone marrow transplantation","volume":"17","author":"Davies","year":"1996","journal-title":"Bone Marrow Transplant"},{"key":"2025082703234718000_14.7.e242513.12","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1702485"},{"key":"2025082703234718000_14.7.e242513.13","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12839"},{"key":"2025082703234718000_14.7.e242513.14","unstructured":"Hyperammonemia [Internet]. 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