BACKGROUND: Cannabinoid hyperemesis syndrome (CHS) can be challenging to identify given its nondescript gastrointestinal symptoms, and its presentation can be further confounded in pregnant patients. The downregulation of transient receptor potential vanilloid-1 receptors (TRPV-1) by cannabinoid use has been hypothesized to be a possible contributor to this syndrome. Topical capsaicin is a promising therapy that can be used to modulate the TRPV-1 system.

CASE REPORT: We present a 34-year-old woman at 11 weeks’ gestation experiencing intractable abdominal pain and nausea. Despite extensive gastrointestinal evaluation and multimodal antiemetic treatment, the symptoms persisted. Oral pain management options were also severely limited, given the pregnancy and potential risk of exacerbating gastrointestinal symptoms. Ultimately, the diagnosis of CHS was proposed, and topical capsaicin cream was trialed with great improvement in symptom control.

CONCLUSIONS: This case underscores the diagnostic challenges of CHS in pregnancy and highlights topical capsaicin as a promising therapeutic option.

KEYWORDS: Topical capsaicin cream, cannabinoid hyperemesis syndrome, hyperemesis in pregnancy, pain management in pregnancy