What's Cyclic Vomiting Syndrome? Woman Pukes 30 Times, Up To 6 Liters A Day

A rare case in which a woman had recurrent vomiting episodes at least 30 times per day, producing up to 6 liters of puke, has stumped doctors.

A case report on the 27-year-old woman's condition was published in the journal Frontiers in Endocrinology.

The case was first presented to the doctors in 2016 when the woman used to suffer from such vomiting episodes once a month. The patient felt an "impending sense of doom and came to our hospital for help in a state of panic" before every bout, the authors wrote. The puking was accompanied with feeling a sense of nausea and extreme abdominal pain.

"The episodes were so severe that the patient had vomiting episodes more than 30 times a day and the vomiting volume could be as large as 6 liters [1.6 gallons]," the authors noted.

After analyzing the patient's symptoms, the doctors diagnosed her with "cyclic vomiting syndrome" (CVS). It is a disorder in which a person undergoes sudden vomiting attacks followed by long asymptomatic periods.

While there is no exact known cause of CVS, as per the National Institute of Diabetes and Digestive and Kidney Diseases, it may occur due to divergent nerve signals between the brain and digestive tract, dysfunctional hormonal responses to stress or certain genetic mutations.

The woman also had Type 1 diabetes. It is an autoimmune disease in which the body's immune cells attack pancreatic cells that produce insulin. Insulin is a hormone responsible for maintaining glucose levels in the blood. The hormone brings down blood sugar levels by directing sugar into the cells.

About one in five people with this disease has another kind of autoimmune disorder, according to a 2020 report in the journal Diabetes Care. For the woman, CVS may have been due to an underlying autoimmune disorder, though doctors still don't know how.

Once her symptoms subsided in the hospital, the woman experienced low blood sugar for days. This was despite the fact that her insulin treatment was in control.

Perplexed by this event, the doctors conducted a full-body exam. "But nothing significant was found," case report author Dr. Wei Liang, a physician in the Endocrinology Department of the University of Hong Kong-Shenzhen Hospital, told Live Science.

One thing did stand out. Blood tests revealed "extremely high" levels of GAD autoantibodies, which were found in patients with type 1 diabetes, Liang said.

"We observed an unusual phenomenon of 'insulin recycling' in this patient," case report author Aimin Xu, a professor at the University of Hong Kong's State Key Laboratory of Pharmaceutical Biotechnology, told the outlet.

In other words, the researchers found that insulin stayed longer in the woman's blood rather than breaking down.

The doctors tried different drugs to bring down antibodies in the body. One such drug, rituximab, was successful in reducing antibody levels and preventing low blood sugar in the woman.

In a happy coincidence, "vomiting symptoms were remarkably reduced in our patient in the eight-month follow-up after one course of rituximab treatment," Liang added. The researchers believe that antibodies were driving CVS in the patient.

"In our opinion, cyclic vomiting syndrome is not likely linked to diabetes or insulin use," Liang said further. "Therefore, we think CVS may be a separate autoimmune disorder."