愷他命相關潰瘍性膀胱炎：病例報告

Ketamine-associated Ulcerative Cystitis: A Case Report

愷他命濫用所造成的慢性危害包括認知障礙、憂鬱、精神病症及上腹絞痛等，而愷他命相關潰瘍性膀胱炎則是近年來新興的臨床議題。本文報告一名28歲女性，主訴嚴重下腹痛、頻尿及解尿困難約一個月，因為初步臆斷為骨盆腔炎症合併泌尿道感染，而接受抗生素治療。由於症狀持續而住院行診斷性腹腔鏡檢查，僅發現輕微骨盆腔沾黏，然而於術中病患導尿管意外出現巨觀性血尿，而臨時施予膀胱鏡檢查，發現膀胱黏膜有瀰漫性紅斑變化、纖維化、潰瘍及多處出血點，病患於術後坦承使用愷他命已約6個月的時間。隨著濫用人數增加，我們預期愷他命相關潰瘍性膀胱炎的病例將愈普遍，臨床上有症狀類似骨盆腔炎症或泌尿道感染的病患，應將此症列入考量。

The chronic harmful effects of ketamine abuse include cognitive impairment, depression, psychosis, and K-cramps. Ketamine-associated ulcerative cystitis is a newly-discovered clinical entity.This paper reports a 28-year-old female who sustained intractable lower abdominal pain, frequency, and dysuria for a period of one month. Under the diagnostic impression of pelvic inflammatory disease and urinary tract infection, she underwent antibiotic treatment. Since her symptoms exacerbated, she was admitted for diagnostic laparoscopy. However, her laparoscopy only noted mild pelvic adhesions. Gross hematuria was visualized in the Foley catheter during the operation. Cystoscopy was performed and revealed diffuse erythematous change, fibrosis, ulceration, and multiple active bleeding points through the vesical mucosa. After the operation, she admitted taking ketamine for approximately 6 months.As ketamine abuse increases, we anticipate greater numbers of patients reporting ketamine-associated ulcerative cystitis. We suggest that if a patient has symptoms similar to either a urinary tract infection or pelvic inflammatory disease unresolved after empiric treatment, clinicians should investigate for a history of drug abuse and approach the patient biopsychosocially. This case can be a useful example for preventing ketamine abuse.