Hyperammonemia without liver disease as a differential diagnostic problem. Two cases with myeloma

Background: Ammonia induced encephalopathy is a common symptom in end-stage liver disease. Hyperammonemia (HA) in non-hepatic diseases such as myeloma and also as a side effect of chemotherapy for malignant diseases has been reported. Here we report non-hepatic HA in two patients with myeloma. Case 1: 79yrs old man was admitted because of altered sensorium. Myeloma multiplex was diagnosed by highly elevated total protein level, biclonal M-components and bone marrow aspiration. No MRI abnormality was found in the brain in the background of the neurological symptoms. The EEG was characteristic for metabolic abnorm…