Bizarre Patient: She Vomits Up to 30 Times a Day for No Reason

A 27-year-old woman walks into the emergency room of a Hong Kong hospital in complete panic. Lately, she has been vomiting up to 30 times a day! The doctors immediately hospitalize her and understand that these vomiting attacks are cyclical: first she suffers from nausea and abdominal pain, then vomits continuously for two to three days before the attacks subside… some time. to start again after. In times of crisis the patient may vomit up to six liters of fluid! It’s not the first time she’s been hospitalized for excessive vomiting, but doctors haven’t figured out the cause of her profuse attacks.

two diseases in one case

The patient was diagnosed at age 12 with type 1 diabetes, a disease that can also cause vomiting but such severe cases are very rare. In addition, between the two bouts of vomiting, the patient experienced severe hypoglycaemia which was not corrected even by injection of insulin by pump. Doctors are therefore faced with two puzzles: the origin of vomiting and the origin of spontaneous hypoglycaemia.

CT scan, endoscopy, MRI, ultrasonography and all other investigations of the patient did not give any clue about the origin of the vomiting. This suggests a case of “cyclic emetic syndrome”, a very rare disease whose cause is not well identified. In general, episodes of vomiting are triggered by an external factor: stress, certain foods, motion sickness… For our patient, it seems her period is the trigger. Treatment involves managing attacks with medication and avoiding triggers when possible.

For young Sugar, it is the treatment against the autoimmune disease that caused her hypoglycemia that finally brings her relief. Indeed, it consists of auto-antibodies that attack both the insulin produced by the body and the insulin injected by its pump, and their action can be counteracted by taking rituximab. This issue, published in 2022 Frontiers in Endocrinology and unique in the medical literature, suggests that cyclic emetic syndrome may be partly autoimmune in origin.