SHM Converge Scientific Abstract ePoster Gallery-Mary Jane and the Chamber Pot: A Case of Cannabidiol-Induced Chronic Diarrhea

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This case report describes a 13-year-old girl with Aicardi syndrome and treatment-resistant epilepsy who developed persistent diarrhea, abdominal pain, intermittent vomiting, and weight loss while taking chronic cannabidiol (Epidiolex). Initial emergency department evaluation showed elevated inflammatory markers and positive fecal occult blood, but stool PCR testing, CBC, CMP, celiac testing, and later abdominal CT, EGD, colonoscopy, and capsule endoscopy were largely unrevealing for infectious, inflammatory, or structural bowel disease.<br /><br />Because her symptoms persisted despite empiric metronidazole and GI workup, clinicians considered other causes, including eosinophilic esophagitis and possible early Crohn disease, but these did not explain the ongoing diarrhea. Eventually, her Epidiolex dose was reduced from 20 mg/kg/day to 15 mg/kg/day, and within three weeks her diarrhea improved markedly.<br /><br />The authors highlight that cannabidiol is increasingly used for refractory epilepsy and related neurodevelopmental syndromes, but adverse effects are common. Diarrhea, decreased appetite, somnolence, and weight loss are recognized side effects, even though cannabinoids are traditionally thought of as anti-diarrheal. The mechanism for cannabidiol-associated gastrointestinal symptoms remains unclear, but proposed explanations include altered endocannabinoid signaling, excipient-related reactions, or interactions with gut inflammation and microbiome changes.<br /><br />The key message is that cannabidiol should be included in the differential diagnosis of chronic diarrhea, especially when extensive evaluation is negative and symptoms correlate with dose escalation or improve after dose reduction.

Asset Subtitle

Maitri Patel

Meta Tag

Author List Howard Goodkin, Jeremy Middleton, Maitri Patel

Category Clinical Vignettes

Concept Cannabidiol

Concept Diarrhea

Concept Abdominal Pain

Concept Weight Loss

Concept Persistent Diarrhea

Distinguished Non-Finalist

Presenter Organization University of Virginia School of Medicine

Presenting Author Maitri Patel

Track Pediatric

Keywords

Aicardi syndrome

treatment-resistant epilepsy

cannabidiol

Epidiolex

chronic diarrhea

abdominal pain

weight loss

gastrointestinal adverse effects

fecal occult blood

dose reduction

Cannabidiol

Diarrhea

Abdominal Pain

Weight Loss

Persistent Diarrhea