Long-term colchicine administration leading to colchicine toxicity and death

✍ Scribed by Michael N. Neuss; Rex M. McCallum; Wayne D. Brenckman; Harold R. Silberman

• Book ID: 101646472
• Publisher: John Wiley and Sons
• Year: 1986
• Tongue: English
• Weight: 201 KB
• Volume: 29
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780290324

✦ Synopsis

Extracts from the Colchicum autumnale plant have lbeen used to treat gout since the sixth century (I), and many instances of accidental or intentional overdose have been reported (24). Although a clinical syndrome due to acute colchicine intoxication is wellknown, we know of no reports of its occurrence while a patient was taking usual prophylactic doses. The following case study may be the first reported example of such an event.

Case report. The patient, a 60-year-old woman, was hospitalized in April 1983 for evaluation of fatigue, edema, myalgias, and gradually progressive weakness. Her history included diabetes, hypertension, non-crystal-proven gout, and severe atherosclerosis with atherosclerotic stenosis of the right renal artery, for which nephrectomy was performed, with a subsequent baseline creatinine level of 2.3 mg/dl. After she had an allergic reaction to allopurinol in early 1982, her gout was treated regularly with colchicine, 0.6 mg twice daily. With this therapy, she was free of acute gouty attacks but had almost constant nausea; however, she found the latter more tolerable than her previous episodes of acute arthritis.

Initial physical findings included peripheral edema, bibasilar rales, an S3 gallop, and hypoactive deep tendon reflexes. She was tentatively diagnosed as having congestive heart failure and diabetic neuropa-From the