Ketamine-Induced Cholangiopathy With Concomitant Hemorrhagic Cystitis: An Emerging and Underrecognized Cause of Cholestasis.
Kamran Nazir, Waqas Ahmed, Salman Rafi, Adeel Ahmad, Asim Khaleeq
Cureus December 1, 2025 DOI: 10.7759/cureus.99972 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 55-year-old female with recurrent hemorrhagic cystitis and chronic ketamine use |
| Intervention | cessation of ketamine use |
| Topics | Esketamine Ketamine |
| Keywords | Biliary stricture Hepatobiliary complication Ketamine-induced cholangiopathy Ketamine-induced cystitis Recurrent hemorrhagic cystitis |
| Key findings | Ketamine-induced cholangiopathy with biliary stricturing and concurrent hemorrhagic cystitis improved biochemically after cessation of ketamine use. |
Abstract
Ketamine-induced cholangiopathy (KIC) is a rare but increasingly recognized manifestation of chronic ketamine toxicity, often accompanied by urinary tract injury such as hemorrhagic cystitis. We report the case of a 55-year-old female with recurrent hemorrhagic cystitis and a long-standing history of intermittent recreational ketamine use who presented with asymptomatic cholestatic liver enzyme abnormalities. Hepatobiliary ultrasound revealed hepatic steatosis without ductal dilatation, and magnetic resonance cholangiopancreatography demonstrated multifocal biliary stricturing with a beaded appearance of the intrahepatic bile ducts. Serological testing for autoimmune and infectious etiologies was negative. Cystoscopy revealed inflammatory bladder changes, and histopathology confirmed ketamine-induced hemorrhagic cystitis. Following cessation of ketamine use, the patient demonstrated biochemical improvement. This case emphasizes the multisystem toxic potential of ketamine, highlighting the importance of recognizing KIC with concomitant hemorrhagic cystitis as an emerging cause of cholestasis and urinary tract injury.