Abstract
Background: A 32-year-old Caucasian man presented with intractable nausea, psychogenic vomiting, abdominal pain and compulsive hot-water bathing behaviors following the habitual use of cannabis for years, consistent with the uncommon and frequently overlooked diagnosis of Cannabinoid Hyperemesis Syndrome. This was his third admission to the emergency department with the same complaints and symptoms which had persisted for over two years without a recognizable etiology. All imaging studies done on each visit were unremarkable.n Results: The patient was clinically symptomatic with the aforementioned presenting complaints, but disappeared upon discontinuation of the cannabis. Within two days of supportive treatment in addition to temporary relief of symptoms with bathing. To date, noeffective cure has been sought for this unique diagnosis other than abstaining from cannabis use. Conclusion: A complete recovery was made three days following admission. The presenting symptoms were attributed to the smoking behaviors. The patient was followed up by his primary care physician once released from the hospital. A very rare diagnosis surfaced a number of times with the same patient in the same setting over the span of a couple years, but was overlooked due to its rarity. Hence, physicians should list it higher on their
 differentials when dealing with a patient with a history of drug abuse.
Highlights
Cannabinoid Hyperemesis Syndrome (CHS) was first noted by Allen JH, and De Moore GM, when they explored the association between chronic cannabis abuse and a cyclical vomiting illness that presented in a series of cases in South Australia in 2004.1 It is a syndrome characterized by the chronic use of cannabis, recurrent episodes of severe nausea, vomiting, abdominal pain, and habitual bathing behaviors to help resolve symptoms
The mechanisms explaining the adverse consequences of long-term cannabis toxicity remain largely unknown, various pathogenic mechanistic theories maintain that several peripheral CB1 cannabinoid receptors in the brain are responsible for the presenting signs and symptoms.[1]
In a survey conducted by Venkatesan T, et al, revealed that 89% of the patients with chronic vomiting were not diagnosed in the emergency department.[3]
Summary
Cannabinoid Hyperemesis Syndrome (CHS) was first noted by Allen JH, and De Moore GM, when they explored the association between chronic cannabis abuse and a cyclical vomiting illness that presented in a series of cases in South Australia in 2004.1 It is a syndrome characterized by the chronic use of cannabis, recurrent episodes of severe nausea, vomiting, abdominal pain, and habitual bathing behaviors to help resolve symptoms (a pathognomonic feature). A 32 year old male presented to the Dekalb Medical Center Emergency Department in Atlanta, Georgia for nausea, nonbloody vomiting, and diffuse colicky abdominal pain over the course of a week.
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