Korean J Crit Care Med.  2015 Aug;30(3):207-211. 10.4266/kjccm.2015.30.3.207.

Acute Colchicine Poisoning Treated with Granulocyte Colony Stimulating Factor and Transfusion

• Lee SH
• Park SW
• Han SK
• Park SC

• KMID: 2227651
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.207

Abstract

Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.

Keyword

colchicine; neutropenia; toxicity

MeSH Terms

Blood Transfusion
Colchicine*
Colony-Stimulating Factors*
Eating
Emergency Service, Hospital
Female
Granulocytes*
Humans
Multiple Organ Failure
Neutropenia
Poisoning*
Respiratory Distress Syndrome, Adult
Shock
Thrombocytopenia
Young Adult
Colchicine
Colony-Stimulating Factors

Figure

• 

  Fig. 1. Serial changes in white blood cell count (A), platelet count and the volume of transfused platelet concentration (B), international normalized ratio and volume of transfused fresh frozen plasma (C), and aspartate transaminase and alanine transaminase (D) over time after presentation to the emergency department. Arrow indicates the time of administration of granulocyte colony stimulating factor (G-CSF). ED: emergency department; WBC: white blood cell; ANC: absolute neutrophil count; PLT: platelet; PT: prothrombin time; INR: international normalized ratio; FFP: fresh frozen plasma; AST: aspartate transaminase; ALT: alanine transaminase.

Reference

References

1. Terkeltaub RA. Colchicine update: 2008. Semin Arthritis Rheum. 2009; 38:411–9.

2. Lange U, Schumann C, Schmidt KL. Current aspects of colchicine therapy -- classical indications and new therapeutic uses. Eur J Med Res. 2001; 6:150–60.

3. Harris R, Marx G, Gillet M, Kark A, Arunanthy S. Colchicine-induced bone marrow suppression: treatment with granulocyte colony-stimulating factor. J Emerg Med. 2000; 18:435–40.

4. Cocco G, Chu DC, Pandolfi S. Colchicine in clinical medicine. A guide for internists. Eur J Intern Med. 2010; 21:503–8.

5. Andreu JM, Timasheff SN. Tubulin bound to colchicines forms polymers different from microtubules. Proc Natl Acad Sci U S A. 1982; 79:6753–6.

6. Luduena RF, Roach MC. Tubulin sulfhydryl groups as probes and targets for antimitotic and antimicrotubule agents. Pharmacol Ther. 1991; 49:133–52.

7. Hood RL. Colchicine poisoning. J Emerg Med. 1994; 12:171–7.

8. Murray SS, Kramlinger KG, McMichan JC, Mohr DN. Acute toxicity after excessive ingestion of colchicine. Mayo Clin Proc. 1983; 58:528–32.

9. Borron SW, Scherrmann JM, Baud FJ. Markedly altered colchicines kinetics in a fatal intoxication: examination of contributing factors. Hum Exp Toxicol. 1996; 15:885–90.

10. Folpini A, Furfori P. Colchicine toxicity--clinical features and treatment. Massive overdose case report. J Toxicol Clin Toxicol. 1995; 33:71–7.

11. Critchley JA, Critchley LA, Yeung EA, Young RP, Young RJ, Chan TY, et al. Granulocyte-colony stimulating factor in the treatment of colchicines poisoning. Hum Exp Toxicol. 1997; 16:229–32.

12. Lin PF, Cheng CY, Fang CL, Sue YM. Colchicine poisoning: an unusual cause of diarrhea with multiorgan failure. J Exp Clin Med. 2013; 5:235–6.

13. Milne ST, Meek PD. Fatal colchicine overdose: report of a case and review of the literature. Am J Emerg Med. 1988; 16:603–8.

14. Little A, Tung D, Truong C, Lapinsky S, Burry L. Colchicine overdose with coingestion of nonsteroidal anti-inflammatory drugs. CJEM. 2014; 16:252–6.

15. Baud FJ, Sabouraud A, Vicaut E, Taboulet P, Lang J, Bismuth C, et al. Brief report: treatment of severe colchicine overdose with colchicine-specific Fab fragments. N Engl J Med. 1995; 332:642–5.