An Adolescent Female With Disordered Eating and Cannabis Use Found to Have Acute Intermittent Porphyria.

Abstract

Background: Eating disorders and cannabinoid hyperemesis syndrome are increasingly common causes of nausea, vomiting, and weight loss in adolescent females. Acute intermittent porphyria (AIP) is rare but has considerable pathophysiological overlap with these conditions and requires a high index of suspicion. Purpose and Basic Procedures: We present the case of a 15-year-old girl who presented with nausea, vomiting, and decreased appetite in the context of cannabis use and disordered eating. She was initially discharged from the emergency department but returned the next day experiencing seizures and altered mental status. Medical workup revealed AIP, and she responded well to the appropriate treatment. Main Findings: To date, no literature exists about the overlap between cannabinoid hyperemesis syndrome and AIP, although they often present with similar features. There is scant information about the interplay between AIP and disordered eating. As our case report shows, an AIP diagnosis could be delayed by misattribution of presenting symptoms to cannabis use or disordered eating. Principal Conclusion: AIP is a rare but highly treatable cause of nausea, vomiting, and altered mental status in adolescents. Due to its symptomatologic overlap with more common conditions like cannabinoid hyperemesis syndrome and eating disorders, it is easily missed. Thus, a high index of suspicion is required to obtain an AIP diagnosis and initiate treatment.