Ketamine-induced cystitis: Lessons from a case of recreational use

Area of Science:

• Urology
• Pharmacology
• Toxicology

Background:

• Recreational ketamine use is increasing, posing significant health risks.
• Ketamine-induced cystitis (KIC) is a severe bladder condition associated with chronic ketamine abuse.
• KIC often presents with symptoms similar to infectious cystitis, leading to diagnostic challenges.

Purpose of the Study:

• To detail a case of KIC in a recreational ketamine user.
• To identify diagnostic pitfalls leading to unnecessary antibiotic prescriptions.
• To provide pharmacist-led recommendations for KIC assessment and management.

Main Methods:

• A case report of a 56-year-old male with escalating ketamine use (up to 1 gram weekly).
• Clinical presentation included severe suprapubic pain, dysuria, urinary frequency, and hematuria.
• Diagnostic workup involved physical examination, CT scans, urinalysis, and laboratory tests; causality assessed using the Naranjo algorithm.

Main Results:

• The patient presented with symptoms of severe cystitis and acute kidney injury.
• Imaging revealed pelvic soft tissue stranding and renal cortical scarring.
• Naranjo algorithm score of 4 indicated possible causality between ketamine use and cystitis.

Conclusions:

• KIC can mimic infectious cystitis but is often sterile, necessitating careful diagnosis to avoid inappropriate antibiotic use.
• Management includes ketamine cessation, harm-reduction counseling, non-opioid analgesia, and anti-inflammatory agents.
• Pharmacists are crucial in screening, differential diagnosis, and coordinating care for patients with KIC.