AN UNUSUAL CASE OF MARIJUANA-INDUCED ACUTE PANCREATITIS

Abstract

SESSION TITLE: Critical Care 6 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Cannabis (marijuana) is the most frequently consumed illicit drug in the world. Pancreatitis is one of the least reported adverse effects of cannabis with the literature merely limited to a few anecdotal case reports. Given the increasing illicit and medical use of marijuana globally, the goal of this case report is to increase the awareness on an unusual yet potential adverse effect, namely, acute pancreatitis. CASE PRESENTATION: A 23-year-old African-American male with no significant past medical history presented with sudden onset of epigastric pain. It was associated with nausea and vomiting. Vomitus was non-bloody and non-bilious. He was former social drinker until he quit five months ago. He did admit using marijuana regularly. On examination, vital signs were within normal limits. Examination of the abdomen and other systems were otherwise unremarkable except for epigastric tenderness. He had elevated serum lipase measuring 1387 units/liter. Metabolic parameters including liver function test, serum calcium and triglyceride levels were within normal limits. Abdominal imaging with plain radiograph was unremarkable, ultrasound was negative for cholelithiasis. Computed tomography of abdomen did not reveal a pancreatic edema or necrosis. Urine drug screen was positive for cannabinoids. He was diagnosed with acute pancreatitis likely triggered by cannabis use. He was treated conservatively with bowel rest, acid suppression along with supportive measures. He had an uneventful recovery and was discharged home. At discharge, he was counseled against of marijuana use and was enrolled in a drug rehabilitation program. DISCUSSION: Cannabis contains tetrahydrocannabinol and cannabidiol that acts on CB1 and CB2 receptors. CB1 receptors are present in pancreatic tissue and are thought to be responsible for pancreatic breakdown, although a detail of pathologic mechanism remains a mystery. Cannabis is the world’s most popular illicit drug with over 4% of the word population using it each year. Despite this, acute pancreatitis is a rarely reported adverse effect of cannabis. Reporting drug-induced acute pancreatitis is challenging as it has no distinguishing clinical features. The diagnosis gets further challenged by frequent use of polypharmacy making it difficult to pinpoint the specific offending agent. Thus, the true incidence of cannabis-induced pancreatitis may therefore be underestimated. A high index of clinical suspicion and detailed drug history may therefore be essential in identifying the causality. CONCLUSIONS: Considering, the universally increasing medical and illicit use of cannabis clinicians should be well aware of acute pancreatitis as an uncommon yet potential adverse effect of cannabis. Reference #1: Barkin, J.A., Nemeth, Z., Saluja, A.K. and Barkin, J.S., 2017. Cannabis-Induced Acute Pancreatitis: A Systematic Review. Pancreas, 46(8), pp.1035-1038. DISCLOSURES: No relevant relationships by Soney Basnyat, source=Web Response no disclosure on file for Hira Irfan; no disclosure on file for Banathally Nandish; No relevant relationships by Milan Patel, source=Web Response No relevant relationships by David Steinberger, source=Web Response