長期氯胺酮濫用相關之雙側輸尿管炎、膀胱炎及膽管疾病併發的罕見病例

陳立峰、張議徽

中國醫藥大學附設醫院 泌尿部

A Rare Case of Concurrent Bilateral Ureteritis, Cystitis, and Cholangiopathy Associated with Chronic Ketamine Abuse

Lek-Hong Tan, MD, MPH, Yi-Huei Chang, MD

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction:  Ketamine abuse is a well-known cause of lower urinary tract symptoms and ketamine cystitis. Recent evidence suggests that it is also associated with liver dysfunction and biliary tract abnormalities. This case report describes a rare occurrence of concurrent bilateral ureteritis, cystitis, and cholangiopathy associated with chronic ketamine abuse, which has not been previously reported.

Case presentation:  The patient is a 27-year-old woman who had a past history of ketamine ureteritis and cystitis, and recurrent urinary tract infections. She had a history of recreational ketamine use from the age of 17 to 21 years old, and her symptoms included lower back pain, abdominal pain, nausea, dysuria, and frequent urination. Despite frequent visits to the emergency department and admission to the urology ward for UTI control and changing of Double-J stents, her symptoms persisted. In addition, persistent elevation of serum alkaline phosphatase and liver enzymes was noted. Finally, an endoscopic retrograde cholangiopancreatography revealed a distal common bile duct stricture, which was treated with endoscopic sphincterotomy, and endoscopic ductal biopsies were performed. Pathology results showed fibrotic stroma with chronic inflammation. Following the procedure, the patient's symptoms improved.

Conclusion:  This case highlights the potential for multi-organ damage associated with chronic ketamine abuse and emphasizes the importance of considering this possibility in patients with a history of ketamine use presenting with abnormal liver function tests, biliary tract abnormalities, and lower urinary tract symptoms. It is crucial to recognize and manage the various complications associated with ketamine abuse to prevent further damage and improve patient outcomes.