Ketamine-induced sclerosing cholangitis: a case series.

BACKGROUND: Ketamine-induced sclerosing cholangitis is an under-recognized but emerging condition, associated with chronic recreational ketamine use (1,2). While the bladder dysfunction related to ketamine abuse is well-documented, its hepatobiliary complications are less known (3). The disease mechanism remains unclear. It is suspected that ketamine has an effect on N-methyl-D-aspartate receptors in the bile duct smooth muscle, which contributes to chronic inflammation, fibrosis, and strictures. Patients present with abnormal liver function tests, imaging abnormalities, and aberrant liver biopsy. Management requires cessation of ketamine use, symptomatic treatment and close monitoring to prevent progression to cirrhosis (4-8).

CASES: This case series presents two cases of ketamine-induced sclerosing cholangitis in female patients, a demographic not typically represented in existing literature.

CONCLUSION: A multidisciplinary approach involving gastroenterologists, urologists, and psychiatrists is necessary (5). Long-term studies are needed to better understand the pathophysiology and to approve treatment and management of this disease.