[Cannabinoid hyperemesis with the unusual symptom of compulsive bathing]

Examination of a 36-year-old man revealed no physical or psychological disorders that could explain his chronic, intermittent severe vomiting that did not respond to a wide range of antiemetics. After a recent publication on cannabinoid hyperemesis, the patient was questioned further, and it was found that he was a chronic cannabis smoker since the age of 14 years. This is the first Dutch patient with cannabinoid hyperemesis. The syndrome is characterised by a prodromal phase, during which the patient suffers from nausea several days a week, particularly in the morning. Thereafter, the severity of symptoms increases and the patient can present with recurring episodes of treatment-resistant nausea, continuous vomiting, and colicky abdominal pain. Due to the severity of the vomiting, patients are frequently hospitalised for the treatment of dehydration. A typical sign ofcannabinoid hyperemesis is compulsive bathing in warm water, which is the only way to suppress the symptoms. The mechanism underlying the syndrome has not been clarified, but it is clear that chronic cannabis use is a key factor: discontinuation causes the symptoms to disappear immediately, whereas recommencing the use of cannabis can lead to the recurrence of cyclic vomiting and nausea within a few weeks or months.