A 27-year-old young man, Sandeep (name changed), faced lots of challenges in his early life. His parents, despite their poor financial status, worked hard so that their son could study and go abroad for a better living.
With great efforts, he went to Canada and worked tirelessly for 5 years, currently living a comfortable life.
Recently he came to India for vacation. Just 20 days after arriving from Canada, he started experiencing severe pain in his stomach with constipation and repeated bouts of vomiting.
He tried taking some medication from a couple of places, but nothing seemed to work. Initially, he thought it might be due to food poisoning, but gradually the symptoms worsened.
Worried, he went to an MD doctor who conducted various tests like X-rays, sonography, CT scan, and more, but all reports were normal!
His condition deteriorated further, so he was hospitalized. Even after 5 days of treatment with the MD doctor, there was no improvement in his condition. So, an expert opinion from a gastroenterologist was sought. The gastroenterologist performed an endoscopy and diagnosed him with ulcers.
Although the treatment started, his condition remained the same.
Seeing his son’s deteriorating condition, his parents were extremely worried. Finally, they met Dr. Kapil Kaswala, a family friend of Sandeep’s father, and asked Sandeep to consult Dr. Nisharg Patel for a second opinion as a gastroenterologist.
I reviewed all his files and his history; everything seemed fine in the reports, but something was amiss. After going into great details, I was able to pick up a very small but important point in his case history.
The boy’s father revealed that the boy vomited five to six times in a very short span, followed by chills. The boy then took a hot shower, and the vomiting would stop for two to three hours.
I immediately suspected that the boy was suffering from cyclical vomiting syndrome, the most common cause of which is drug abuse.
However, when I asked the boy if he used any drugs, he denied!!
I prescribed some medicines, reassured the boy’s parents that the vomiting would eventually stop, but he asked the boy to come back for follow-up visits.
Over the next 5 days, the boy returned for three follow-up visits, and his condition remained the same. I became more and more confident of the diagnosis.
On the fourth visit, the boy’s father was not present. I asked the boy directly, since how long are you using marijuana? You must honestly tell me now or else there might be adverse consequences on your health.
The boy eventually admitted that he used marijuana daily. He was too ashamed to tell his parents about his drug use hence he was hiding this fact.
I told Sandeep that I had known the diagnosis for seven days but without his answer I was unable to start the specific treatment, and also reassured that I would not tell the boy’s parents.
I started him on the appropriate treatment & the boy’s vomiting stopped within five days, and he made a full recovery.
Sandeep was also referred to a psychiatrist which provided him with counseling and medication to help him stop using marijuana in the future.
The boy’s parents were still unaware of his drug use. They were relieved that their son was finally healthy.
He is back to Canada and living happily.
Diagnosis: Cannabis Hyperemesis Syndrome leading to cyclical vomiting (vomiting due to excessive marijuana consumption)
Important Points:
- Drug abuse is quite rampant.
- Youths fall prey to such practices due to peer pressure or as part of experimentation, stress, lack of parental supervision, etc.
- His symptoms of frequent vomiting and relief from hot water were classic signs of this condition.
- 70-80% of patients feel relief from vomiting after taking hot showers.
- Reports are usually normal in such cases.
- Meticulous history helps us reach the diagnosis.
- If left undiagnosed and the patient continues to use marijuana, it can lead to the patient’s death.
- It’s very important to think out of the box for such rare diagnoses.