Acute Liver Injury Induced by Synthetic Cannabinoid Abuse

Abstract

Synthetic cannabinoid abuse can manifest with an array of unpredictable reactions ranging from sedation to hallucinations, psychosis, and seizures. Acute liver injury associated with the synthetic cannabinoid use is a rare complication. We present a case of a 22-year-old homeless male presented with abdominal pain and vomiting. He admitted regular synthetic cannabinoid use, and binge alcohol use once a week. Physical examination was remarkable only for mild icterus. The laboratory result shows abnormal liver functions tests. Viral, autoimmune, metabolic and other toxic etiologies of liver injury were ruled out. The acute liver injury was deemed to be secondary to synthetic cannabinoids toxicity. Spice-induced liver injury remains a diagnosis of exclusion after all other identifiable causes ruled out. Clinicians should have a high index of suspicion for synthetic cannabinoid abuse in a patient with acute hepatotoxicity who had a history of polysubstance abuse.

Designer drugs: mechanism of action and adverse effects

“…However, many of these cases were attributed to synthetic cannabinoid use based solely on statements by patients or witnesses, without analytical confirmation of the identity and amount of substances in bodily fluids or remaining drug products. Severe clinical complications that have been reported to be associated with synthetic cannabinoid use include convulsions and seizures (Adamowicz et al 2017;Bäckberg et al 2017;Bebarta et al 2012 Yirgin et al 2018), pneumonia and pulmonary infiltrates (Alhadi et al 2013;Alon and Saint-Fleur 2017;Berkowitz et al 2015;Chinnadurai et al 2016;Ö cal et al 2016), respiratory depression (Alon and Saint-Fleur 2017; Jinwala and Gupta 2012), supraventricular and ventricular arrhythmias (Davis and Boddington 2015;Ibrahim et al 2014;Ozturk et al 2019;Young et al 2012), myocardial ischemia and infarction (Clark et al 2015;Hamilton et al 2017;Hirapara and Aggarwal 2015;McIlroy et al 2016;McKeever et al 2015;Mehta et al 2017;Mills et al 2018;Mir et al 2011;Ozturk et al 2019;Shah et al 2016;Sherpa et al 2015;Tse et al 2014), takotsubo cardiomyopathy (Mohammed 2019), liver injury (Shahbaz et al 2018), acute kidney injury (Argamany et al 2016;Armstrong et al 2019;Bhanushali et al 2013;Buser et al 2014;El Zahran et al 2019;Gudsoorkar and Perez 2015;Kamel and Thajudeen 2015;Katz et al 2016b;…”

Acute Kidney Injury (AKI) in Young Synthetic Cannabinoids Abusers

“…The synthesis of the evidence conducted in the present study permitted us to focus attention on a further aspect of synthetic cannabinoid-induced organic damage. Specifically, a large number of studies address cannabinoid-induced liver damage [ 115 ]. As well as for kidney damage, an increasing number of studies in recent years are addressing the problems of drug-induced liver injury (DILI) and herbal-induced liver damage (HILI), highlighting, as already mentioned, growing interest from health professionals [ 116 , 117 ].…”

Strox: A 3-year study of intoxicated cases admitted to Poison Control Center Ain Shams University Hospitals

“…Although SCs action on cannabinoid receptors CB2 has been associated with liver disease, the exact mechanism of acute liver injury is unknown (Solimini et al, 2017). However, dose-related cumulative oxidative hepatocellular necrosis was proposed as a possible mechanism (Shahbaz et al 2018).…”