Cannabis Triggered Catatonia So Severe It Caused Kidney Failure

Single case report of a 21-year-old male with prior cannabis-induced psychosis presenting with catatonia, rhabdomyolysis, AKI, and sympathetic overactivity. Diagnostic workup included CK, creatinine, urine toxicology, hematologic/hepatic/thyroid panels, CT head, and chest X-ray.

Catatonia is under-recognized as a potential consequence of cannabis use, especially in psychiatrically vulnerable individuals. This case demonstrates that the psychiatric emergency (catatonia) can rapidly become a medical emergency (kidney failure, autonomic instability). Emergency physicians and psychiatrists need to consider cannabis as a catatonia precipitant and monitor for physical complications.

This represents the severe end of the cannabis-psychosis spectrum that RTHC-00201 quantified (4-fold risk, 10-fold with genetic vulnerability) and RTHC-00202 explored genetically. While most cannabis users never experience anything like this, individuals with prior psychotic episodes represent the highest-risk group. The treatment non-compliance dimension adds a clinical reality: patients with substance-use-driven psychosis frequently discontinue medications, creating a cycle of relapse and escalating severity.

Single case report—can't establish how common this cascade is. The patient had prior psychotic episodes and medication non-compliance, making it impossible to attribute the outcome solely to cannabis. No genetic testing was reported (RTHC-00202's CNR1 variant could have been informative). The severity of this case may not represent the typical cannabis-associated catatonia presentation.