# Severe Sepsis Associated With Multiorgan Failure and Precipitating Nonhepatic Hyperammonemia Crisis in Late-Onset Ornithine Transcarbamylase Deficiency: A Case Report and Literature Review

## TL;DR

A case report shows how severe sepsis can reveal a rare metabolic disorder, ornithine transcarbamylase deficiency, through a hyperammonemia crisis.

## Contribution

Highlights a rare case where sepsis unmasked late-onset ornithine transcarbamylase deficiency, offering clinical awareness for similar presentations.

## Key findings

- Severe sepsis can unmask undiagnosed ornithine transcarbamylase deficiency.
- Hyperammonemia crisis occurred in a patient with multiorgan failure due to sepsis.
- Physicians should consider metabolic disorders in sepsis patients with altered mental status and seizures.

## Abstract

Sepsis is characterized by a dysregulated immune response to an infection. It is a major public health problem owing to its high mortality and morbidity. Sepsis is a medical emergency and requires aggressive and timely management. It can cause multiorgan failure, unmask an existing but undiagnosed disease such as ornithine transcarbamylase deficiency (OTCD), or make a known well-controlled disease worse. We present the case of a 52-year-old male who was brought to the emergency department unresponsive. He was diagnosed with severe sepsis which was associated with multiorgan failure and hyperammonemia crisis. Hyperammonemia was due to a newly diagnosed, late-onset OTCD which was unmasked by severe sepsis. This case will enable physicians to be aware and consider OTCD in a patient presenting with severe sepsis, altered mentation, and seizures, with no obvious cause of hyperammonemia.