A Rare Case of Cannabis-induced Acute Pancreatitis.

Christian Nehme,Sami Ghazaleh,Aya Abugharbyeh,Tamer S Said Ahmed,Ali Alqahtani

doi:10.7759/cureus.4878

Abstract

Acute pancreatitis is a sudden inflammatory condition of the pancreas, caused mainly by gallstones and alcohol abuse. A significant proportion of acute pancreatitis cases remain idiopathic. Recent reports have highlighted cannabis use as an etiology of acute pancreatitis. A few case reports are available that report the association of cannabis with acute pancreatitis. Considering the global use of cannabis medically and illicitly, it becomes imperative to explore this adverse effect of cannabis use especially in idiopathic cases of acute pancreatitis. Here, in this report, we present a case of acute pancreatitis with no obvious cause. The patient was a 48-year-old female with no history of alcohol use. She had a history of cholecystectomy with normal serum triglycerides and calcium levels. The patient was consuming marijuana (cannabis) daily for the last three years. The diagnosis of cannabis-induced acute pancreatitis was made in the patient after other causes were excluded. It is difficult to distinguish cannabis-induced pancreatitis as there are no clear and specific associated clinical features. The diagnosis of cannabis-induced pancreatitis becomes even more challenging due to the use of multiple drugs. It becomes difficult to point out the causative agent among the multitude of drugs. Hence, a detailed history of drug intake in cases of acute pancreatitis may help to identify the candidature of the drugs in the pathogenesis of the disease. In view of the increasing illicit and medical use of cannabis, it becomes quintessential for clinicians to consider pancreatitis as a possible adverse effect of cannabis.

Highlights

Acute pancreatitis is a common condition that has high morbidity and mortality [1]
In the United States, acute pancreatitis is commonly caused by gallstones, alcohol, hypertriglyceridemia, hypercalcemia, post-endoscopic retrograde cholangiopancreatography (ERCP), medications, and infections [2]
Several cases have been reported in the literature linking cannabis use with the development of acute pancreatitis [4,5,6]

Summary

Introduction

Acute pancreatitis is a common condition that has high morbidity and mortality [1]. An effort is usually made to identify the etiology of acute pancreatitis to guide therapy and prevent a recurrence. Cannabis-induced acute pancreatitis was diagnosed in patients with a history of marijuana use who underwent extensive workup that failed to identify an underlying cause. In this sense, cannabis-induced acute pancreatitis may contribute. Chills, weight changes, diarrhea, constipation, jaundice, hematemesis, hematochezia, melena, chest pain, shortness of breath, or cough She had a history of type 2 diabetes mellitus, essential hypertension, hyperlipidemia, and gastroesophageal reflux disease (GERD). Initial laboratory work showed a normal complete blood count (CBC) and basic metabolic panel (BMP) except for elevated glucose of 270 mg/dL She had mildly elevated aspartate aminotransferase (AST) of 53 U/L and alanine aminotransferase (ALT) of 47 U/L. She was informed that the cause of her acute pancreatitis was unclear, but the most likely culprit was her heavy marijuana use

Discussion

Conclusions

Disclosures