Introduction: Pneumomediastinum (PM) is the presence of free air or gas within the mediastinum. It is often called spontaneous pneumomediastinum (SPM) in the absence of trauma or a clear secondary cause. The incidence of SPM is reported between 0.001% and 0.014% of hospitalized patients and is more commonly seen among young adult males. We report a case of a 22-year-old male who developed SPM and pneumopericardium secondary to cannabinoid hyperemesis syndrome (CHS). Case Description/Methods: We report a case of a 22-year-old male with a history of CHS who presented to the hospital with complaints of intractable nausea, vomiting, and generalized abdominal pain. The patient denied fever, chills, hematemesis, melena, or hematochezia. The patient has had similar episodes in the past treated with anti-emetics, not requiring hospital admission. On admission, vitals were stable. Clinical laboratory results showed hypokalemia 3.3. Serum lipase was normal. Urinalysis was positive for cannabinoids. Electrocardiogram showed a normal sinus rhythm, no ST-T wave changes. Physical exam revealed a soft abdomen with diffuse abdominal tenderness and no signs of peritonitis, and the lungs were clear to auscultation. Subcutaneous crepitus was noted over the chest wall. A Computed Tomography (CT) of the abdomen with intravenous contrast showed no acute intra-abdominal pathology and the presence of PM. CT chest with intravenous and oral contrast showed extensive pneumomediastinum, a small pneumopericardium, and no extravasation of oral contrast. The patient was transferred to the intensive care unit for closer monitoring, and cardiothoracic surgery was consulted. The patient was treated conservatively, with complete recovery (Figure 1). Discussion: SPM is a rare condition characterized by free air in the mediastinum not preceded by thoracic trauma. It consists of a triad of thoracic pain, subcutaneous emphysema, and dyspnea. In a retrospective review, Weiss et al. reported 14 cases of marijuana use associated with PM. SPM results from alveolar rupture following an acute rise in intra-alveolar pressure. Cannabinoids have been used for their antiemetic properties, which are mediated by the cannabinoid receptor CB1. The stimulation of CB1 receptors can suppress gastric emptying in a dose-dependent manner, which may contribute to symptoms seen in CHS. In our case, PM may have resulted from the rupture of a subpleural bulla caused by forceful vomiting. The treatment of SPM is usually conservative and surgery is reserved for unstable patients.
Introduction: Kratom is a herbal derivative of an evergreen species, Mitragyna speciosa. Extracts have been used as an opioid replacement in treating chronic pain as they contain partial mu-opioid receptor activity (Schimmel et al.). Although rare, chronic kratom use has been seen to cause a cholestatic pattern of liver injury with severe hyperbilirubinemia. Our case presents a 36-year-old male who presented with drug-induced hepatocellular liver injury due to chronic kratom use. Case Description/Methods: We report a case of a 36-year-old male with a history of alcohol dependence who presented to the hospital for evaluation of intermittent chest pain. On admission, the patient's vital signs were stable. Physical examination revealed mild epigastric tenderness. Electrocardiogram showed normal sinus rhythm without ST-T wave changes. Clinical laboratory results showed significant transaminitis in a pure hepatocellular pattern with aspartate aminotransferase (AST) 1162 and alanine aminotransferase (ALT) 913, representing an R factor of 55.9. Gamma-glutamyl transferase (GGT) level was 208. Total and direct bilirubin levels were normal. The coagulation profile and hepatitis panel were unremarkable. Prior evaluation four months ago showed AST of 111 and ALT of 132. Computed Tomography (CT) of the abdomen and ultrasonography showed evidence of hepatic steatosis. Discontinuation of kratom during the hospital course showed improvement in transaminase levels, and the patient was discharged with continued liver function monitoring outpatient. Discussion: The interaction of alcohol and kratom has not been well studied. The literature review demonstrated case reports showing a cholestatic pattern of liver injury; however, our patient's case did not align with these findings, most notably with normal total and direct bilirubin levels. Drug-induced liver injury is usually dose-dependent, as seen with improved liver function with kratom abstinence in our case. The mechanism of injury due to regular kratom use has not been well established; however, recent studies show hepatic upregulation of a ligand-gated transcription factor leading to increased toxic metabolite formation. We hypothesize that the combination of kratom and alcohol is potentially synergistic in causing acute drug-induced liver injury. Robust medical profiles of herbal supplementation are lacking yet crucial in clinical awareness and patient education.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.