SHM Converge Scientific Abstract ePoster Gallery-Chronic Pain and Self-Medication in Rheumatoid Arthritis: A Case of Cannabinoid Hyperemesis Syndrome

Pdf Summary

This case report describes a 50-year-old woman with seropositive rheumatoid arthritis, peptic ulcer disease, and chronic pancreatitis who presented with a week of nausea, vomiting, and diarrhea. She had experienced similar episodes about five times per year since her rheumatoid arthritis diagnosis and had been using marijuana 3–4 times daily to manage chronic joint pain. A key feature was symptom relief with warm baths. Workup showed mild electrolyte abnormalities (hyponatremia, hypokalemia, hypochloremia, elevated anion gap), but CT abdomen was unremarkable.<br /><br />She improved rapidly with lorazepam, prochlorperazine, topical capsaicin, IV fluids, and electrolyte correction, with resolution of symptoms within 48 hours. Based on the classic cyclic vomiting pattern, chronic cannabis use, hot shower relief, and lack of intra-abdominal pathology, she was diagnosed with cannabinoid hyperemesis syndrome (CHS).<br /><br />The summary highlights CHS as a functional gut-brain disorder characterized by stereotypical episodic vomiting in the setting of chronic cannabis use. Proposed mechanisms involve dysregulation of cannabinoid receptors with chronic exposure, while TRPV1 activation may explain the benefit of hot showers and topical capsaicin. Diagnosis is guided by Rome IV criteria, and acute treatment includes fluids, electrolyte replacement, capsaicin, dopamine-antagonist antiemetics, and benzodiazepines. Long-term management requires cannabis cessation and addressing the underlying reason for use—in this case, rheumatoid arthritis pain—along with possible mental health or addiction support.

Asset Subtitle

Ellenor Chi

Meta Tag

Author List Ellenor Chi, Ganiru Mathis, Kevin Stanko

Category Clinical Vignettes

Concept Cannabinoid Hyperemesis Syndrome

Concept Marijuana Use

Concept Cannabis Cessation

Concept Rome IV Criteria

Concept Hot Bathing Behavior

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Ellenor Chi

Track Adult

Keywords

cannabinoid hyperemesis syndrome

chronic cannabis use

cyclic vomiting

hot shower relief

topical capsaicin

rheumatoid arthritis

nausea and vomiting

electrolyte abnormalities

Rome IV criteria

cannabis cessation

Cannabinoid Hyperemesis Syndrome

Marijuana Use

Cannabis Cessation

Rome IV Criteria

Hot Bathing Behavior