Synthetic Cannabinoid Abuse and a Rare Alpha-1-Antitrypsin Mutant Causing Acute Fulminant Hepatitis: A Case Report and Review of the Literature.

Kurt J Knowles,Abhishek Seth,Kenneth Manas,Eric X Wei,Moheb Boktor,John Bienvenu,Paul Jordan,James Morris

doi:10.1155/2017/9627452

Abstract

Synthetic cannabinoids (SCs) abuse is on the rise because they are easily obtained over the counter; they are potent psychoactive compounds and routine drug testing does not detect them. As their abuse is on the rise, so are their detrimental side effects; however, the occurrence of acute hepatitis due to SCs abuse has been reported only once before. In this case, testing revealed that the patient was also heterozygous for alpha-1-antitrypsin (A-1-AT) with the phenotype of PI⁎EM. This mutant phenotype has never been reported as a cause of A-1-AT disease and the abuse of SCs in a patient with this phenotype has also never been reported. This case illustrates the possible need to expand routine drug testing for SCs and consider A-1-AT phenotyping in certain clinical scenarios.

Highlights

SCs are known as spice or K2, and their abuse has increased over the past few decades; they are associated with severe toxicity including seizures, cardiac arrhythmias, acute kidney injury, extreme agitation, and shortness of breath [1], but acute liver failure has only been reported once before [2]
A patient with a history of synthetic marijuana abuse was admitted for hepatitis and jaundice
SCs, known as spice or K2, are a diverse group of chemicals that act on the central nervous system’s cannabinoid receptors but are significantly more potent than naturally occurring delta-9-tetrahydrocannabinol. Their abuse has increased over the past few decades in part because in some states they can be obtained over the counter and routine drug testing does not detect them

Summary

Introduction

SCs are known as spice or K2, and their abuse has increased over the past few decades; they are associated with severe toxicity including seizures, cardiac arrhythmias, acute kidney injury, extreme agitation, and shortness of breath [1], but acute liver failure has only been reported once before [2]. The association with mutant phenotypes of alpha-1-antitrypsin has never been reported before and the phenotype Pi∗EM has never been associated with disease of any type. This case report describes the clinical and pathologic consequences of using SCs in a patient with Pi∗EM phenotype

Case Report

23.2 Negative

Discussion

Findings

Conclusions

Conflicts of Interest