Beyond the high-hematuria from ketamine-induced retroperitoneal hematoma: A unique case report

Ketamine, an N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist, is extensively utilized as an anesthetic. Its dissociative and hallucinogenic properties have inspired its widespread recreational use, notably in rave culture. Ketamine abuse has been associated with various adverse health effects, primarily focusing on urogenital and hepatic complications. This case report presents a unique and complex clinical scenario of a 40-year-old male with a history of chronic ketamine misuse disorder, chronic kidney disease (CKD) stage 3A, and chronic interstitial cystitis with intermittent hematuria, who developed severe anemia, bilateral retroperitoneal hematomas, and hematuria. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was also found on blood cultures. To date, life-threatening hematological complications from illicit ketamine use have not been well-documented. Furthermore, retroperitoneal hematoma has not been previously reported as a consequence of ketamine abuse. This case highlights bleeding diathesis post-ketamine abuse as a growing concern, exacerbated by increased substance accessibility. The findings underline the imperative for clinicians to conduct thorough organ system evaluations in cases of suspected ketamine misuse.