A 29-year-old man with long-term heavy cannabis use presents with recurrent episodes of severe nausea and vomiting lasting days. He is noted to take multiple hot showers throughout the day, which he says is the only thing relieving his symptoms. Endoscopy is normal. What is the most likely diagnosis?

• A Cannabinoid hyperemesis syndrome ✓
• B Cyclic vomiting syndrome of non-drug origin
• C Cannabis-induced psychotic disorder with somatic passivity
• D Opioid-induced nausea

Explanation

Cannabinoid hyperemesis syndrome occurs with chronic heavy cannabis use and consists of cyclical intractable vomiting, abdominal pain, and the pathognomonic compulsive hot bathing behaviour, which temporarily relieves symptoms through cutaneous vasodilation and TRPV1 effects. Symptoms resolve with sustained abstinence. Normal endoscopy excludes structural disease, and relief by hot showers distinguishes it from ordinary cyclic vomiting syndrome.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.