before initiation of UST treatment. Although the serum level of KL-6 as a marker of IP was high (2149 U/mL; normal range, 0-499), the patient had no clinical symptoms of respiratory disease. In addition, chest computed tomography (CT) (Fig. 1) showed no interstitial shadows such as shown in usual IP or a non-specific IP, and there was no consolidation in the lobe. After two administrations of UST, she developed a clinical symptom of a cough and the serum KL-6 was elevated to 6809 U/mL. The b-D-glucan was normal and systemic CT showed no malignancy in the internal body. A chest CT revealed consolidation shadows in both lobes. Respiratory physicians consulted about the symptom diagnosed IP. After discontinuation of UST, the consolidation shadows on the lung had diminished and KL-6 had decreased to the initial level. From these findings, we concluded the respiratory phenomenon was UST-induced IP.In case 2, a 60-year-old man had a 10-year history of psoriasis. Before administration of UST, IFX and cyclosporin had been used, however, they had been discontinued due to infusion reaction or insufficient efficacy. UST was then begun, and the initial serum KL-6 level was 1046 U/mL. He had no risk factor such as elderliness, diabetes mellitus or low albumin. After 2 years of treatment with UST, the serum KL-6 was elevated to 2149 U/mL. Systemic CT showed no malignancy in the internal body and chest CT showed consolidation shadows in the left lobe which a respiratory physician diagnosed as IP. Since the use of UST has been discontinued, the shadows have diminished and KL-6 has decreased to the initial level.Little is known regarding the mechanism of UST-induced IP. Although there are some reports of anti-TNF-a agent-induced IP, 3,4 it is difficult to prove that these agents actually cause this condition. In both cases, there were similar points of a high KL-6 level at the initiation of treatment with UST. We have treated approximately 200 patients who received UST. There were three patients showing KL-6 of more than 1000 ng/mL in patients who were treated within our institution. IP developed in two of them. After discontinuation of UST, at least a period of 6 months was needed to return to baseline in the level of KL-6. To detect the increase of KL-6, blood examination should be performed every 3 months during treatment.
Purpose: Ketamine abuse has been a worldwide issue recently. Ketamine-induced cystitis (KC) is an annoying urinary tract symptom secondary to long-term ketamine abuse. The aim of our study is to review clinical outcomes of bladder augmentation enterocystoplasty (AE) for the patients with KC. Materials and Methods: We performed bladder AE for eight patients with refractory symptoms of KC (severe bladder pain, micturition pain, urgency, frequency, and contracted bladder). All the patients received conservative treatment at clinics or referred from other hospital. Results: Between 2007 and 2015, eight patients (seven males and one female), aged 26–48 years (mean 32.7 years), underwent AE as indicated. The duration of ketamine abuse ranged from 2 to 15 years (mean 6.8 years). Contracted bladder was noted in all patients, hydronephrosis in two and hydroureter in one under intravenous pyelography. Postoperative hospitalization ranged from 12 to 47 days (mean 22.4 days). Significant increases in estimated glomerular filtration rate (86.43 ± 21.47 vs. 103.14 ± 29.32 ml/min/1.73 m2,P < 0.05), functional bladder capacity (47.75 ± 10.07 vs. 273.13 ± 54.96 ml,P < 0.0001), and pain visual analog score (6.0 ± 1.2 vs. 1.75 ± 0.89,P < 0.0001) were noted after AE. Surgical complications included adhesion ileus, progressive impaired renal function, and enterovesical fistula. All the patients were satisfied with the outcomes of the surgery, based on their responses to the self-report questionnaires. All patients reported marked improvement in micturition pain and urinary frequency, which greatly elevated life quality. Most patients were followed up at the outpatient department within 1 year or were lost to follow-up after surgery. Conclusion: This case series demonstrated that for surgical management of refractory bladder pain and low bladder capacity resulting from KC, AE might be effective. However, cessation of ketamine use is the most important to prevent recurrence of the above symptoms.
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