SHM Converge Scientific Abstract ePoster Gallery-Innumerable Liver Abscesses in a Patient With Surreptitious Ketamine Use

Pdf Summary

This case describes a 27-year-old previously healthy Chinese-American woman who presented with 1 week of sore throat, flank pain, dysuria, weakness, sepsis, acute kidney injury, and marked cholestatic liver enzyme elevation. On exam she was ill-appearing, cachectic, tachycardic, hypotensive, and had right upper quadrant and bilateral costovertebral angle tenderness. Labs showed leukocytosis, hyponatremia, elevated BUN/creatinine, and very high alkaline phosphatase and GGT. Urine culture grew E. coli, while blood cultures were negative. CT imaging revealed bilateral hydroureteronephrosis, diffuse ureteral wall thickening, and innumerable hypoattenuating liver lesions consistent with abscesses.<br /><br />She initially denied substance use, but after further questioning admitted to years of intranasal ketamine use. Her presentation was therefore felt to represent ketamine-induced uropathy with urinary obstruction, resulting in pyelonephritis and secondary hepatic abscess formation. The presumed mechanism was chronic ketamine-related bladder and ureteral injury causing urinary retention and altered urinary anatomy, which predisposed her to upper urinary tract infection and eventual hematogenous or contiguous spread to the liver.<br /><br />She was treated for sepsis with broad-spectrum antibiotics, later narrowed to ceftriaxone based on E. coli sensitivities. Urology performed cystoscopy with bilateral ureteral stent placement, which improved symptoms. She was discharged after 5 days on oxybutynin and cefuroxime to complete a 4-week antibiotic course.<br /><br />The key teaching points are that ketamine uropathy should be considered in young patients with urinary retention, hydronephrosis, renal failure, or unexplained hepatic injury, and that careful, specific questioning about illicit drug use is crucial. Hepatic abscesses are a rare but serious complication of chronic ketamine abuse.

Asset Subtitle

Cindy L. Tsui

Meta Tag

Author List Cindy L. Tsui, Erwin Wang

Category Clinical Vignettes

Concept Ketamine-Induced Uropathy

Concept Substance Use History

Concept Ketamine

Concept Urinary Retention

Concept Hydronephrosis

Distinguished Non-Finalist

Presenter Organization NYU Grossman School of Medicine

Presenting Author Cindy L. Tsui

Track Adult

Keywords

ketamine uropathy

hepatic abscess

pyelonephritis

urinary obstruction

hydroureteronephrosis

acute kidney injury

E. coli infection

sepsis

intranasal ketamine

cholestatic liver injury

Ketamine-Induced Uropathy

Substance Use History

Ketamine

Urinary Retention

Hydronephrosis