Complete reversal of the clinical symptoms and image morphology of ketamine cystitis after intravesical hyaluronic acid instillation: A case report

We presented an interesting case with a 36-year-old man who's symptoms mimic acute prostatitis but there was no positive pathogen been cultured. The computed tomography (CT) findings revealed asymmetrical bladder wall thickening, which misleading us to the impression of bladder cancer. After the cystoscopy with bladder biopsy, the pathology revealed severe inflammation without malignancy. After that, we prescribed anticholinergic agent, beta-3 agonist and nonsteroidal anti-inflammatory drug (NSAID) for him, but in vain. Diagnoses: Erosive cystitis with prominent infiltration by eosinophils, lymphocytes, neutrophils and plasma cells. Interventions: Then we introduced hyaluronic acid (HA) instillation, once a week for total 10 times. Outcomes: After the treatment, his urgency, frequency, nocturia improved and his bladder capacity increased from less than 100ml to 350mL per urination. The following magnetic resonance imaging (MRI) and bladder biopsy result revealed complete reversal. Lessons: To our literature review, this is the first case of ketamine cystitis presented with asymmetrical bladder wall thickening, which may be considered as an irreversible change, but turns out complete reversal of the clinical symptoms and image morphology after merely intravesical hyaluronic acid instillation
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research