Cannabis as an Overlooked Cause of Acute Pancreatitis: A Case Report and Literature Review

Abstract

Biliary tract disease, ethanol abuse, infections, autoimmunity, and genetics are well known causes of Acute Pancreatitis (AP). However, in 20% of acute pancreatitis cases, the workup still fails to reveal an etiology and these cases are labeled as idiopathic. Cannabis use is emerging as a rare and overlooked cause of idiopathic acute pancreatitis with few cases reported in literature to date. Here we present a case of an 18-year-old African American female with a history of Ventral Septal Defect who presented to our hospital with epigastric abdominal pain radiating to the back for 2 days associated with nausea and non-bloody emesis. On physical exam, tenderness to light palpation was noted in the epigastrium and RUQ region. The clinical presentation along with laboratory data showed an elevated lipase level of 812 U/L and amylase of 481 U/L confirming the diagnosis of an acute pancreatitis. The rest of her laboratory data was significant for Hgb 11.5g/dL, Hct 36.7%, MCV 75.3, creatine kinase 461, and calcium level of 8.9 mg/dL. Urine toxicology was positive for cannabinoids and upon further exploration, patient admitted to smoking marijuana twice a week for the past two months. Her home medications included depot-medroxyprogesterone for contraception and she denied taking over the counter supplements or any other illicit drugs. Her last alcoholic drink was 2 weeks earlier and abdominal ultrasound ruled out cholelithiasis and choledocholithiasis. Immunoglobulins with IgG4 subclass was normal and her triglyceride level was 65 mg/dL. Patient was hospitalized and treated with supportive care with resolution of her presenting symptoms without recurrence of her pancreatitis to date. Only five cases of cannabis-induced acute pancreatitis (AP) have been reported in the United States till 2017. Literature reviewed has showed that only 26 cases of cannabis-induced AP have been reported worldwide. Patients in majority of these cases were males under the age of 35 years. In our case study, the patient was an eighteen-year-old female, which is a rarely reported gender population. In conclusion, we feel that health care providers should include cannabis in their differential diagnosis of idiopathic AP cases, particularly in patients under 35 years of age.