Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2014; 2(12): 930-933
Published online Dec 16, 2014. doi: 10.12998/wjcc.v2.i12.930
Case of cannabinoid hyperemesis syndrome with long-term follow-up
Jae Myung Cha, Richard A Kozarek, Otto S Lin
Jae Myung Cha, Gastroenterology Division, Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul 134-727, South Korea
Richard A Kozarek, Otto S Lin, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Cha JM designed the case report and provided discussion of the clinical implication; Cha JM, Kozarek RA and Lin OS contributed to the writing of the manuscript; all authors approved the final version to be published.
Correspondence to: Otto S Lin, MD, PhD, Digestive Disease Institute, Virginia Mason Medical Center, C3-Gas, 1100 Ninth Avenue, Seattle, WA 98101, United States.
Telephone: +1-425-6257373
Received: May 20, 2014
Revised: July 24, 2014
Accepted: September 23, 2014
Published online: December 16, 2014

Long-term cannabis use may be associated with attacks of severe nausea and vomiting, and a characteristic learned behavior of compulsive hot bathing, termed cannabinoid hyperemesis syndrome (CHS). Long-term follow-up and prognosis of CHS have not been reported previously. A 44-year-old Caucasian man with a long history of addiction to marijuana presented with chronic abdominal pain complicated by attacks of uncontrollable vomiting for 16 years. He had a compulsion to take scalding hot showers, as many as 15 times a day, to relieve his symptoms. All previous therapies had been ineffective. However, abstinence from marijuana led to rapid and complete resolution of all symptoms and his compulsive hot showering behavior. He has been followed for nine years, and is still doing well without recurrence of symptoms. Physicians should have a high index of suspicion for this under-recognized condition, as excellent long-term prognosis of CHS can be achieved when abstinence is maintained.

Keywords: Cannabinoids, Hyperemesis, Prognosis, Abdominal pain, Adverse drug effect

Core tip: Cannabinoid hyperemesis syndrome (CHS) can be diagnosed with characteristic clinical features, including long-term cannabis use, severe cyclical abdominal pain, nausea and vomiting, and temporary relief of symptoms with hot showers or baths. Excellent long-term prognosis of CHS can be achieved when abstinence from cannabinoid is maintained. Physicians should have a high index of suspicion in patients with unexplained chronic abdominal pain and vomiting.