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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)

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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.

Comparable studies

Other case reports and case series on ketamine, most cited first.

Study Year Design Participants
The destruction of the lower urinary tract by ketamine abuse: a new syndrome? Young recreational abusers of street-ketamine in Hong Kong referred to urology units 2008 Retrospective case series n = 59
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions Chronic and treatment-resistant eating disorder patients 1998 Case series n = 15
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4

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