Colchicine Intoxication Subsequent to an Autolytic Attempt with Positive Evolution

Abstract

Background and objectives: Colchicine is a drug that has been used to treat gout for several centuries, it is also indicated in certain autoimmune diseases and has been tested as a chemotherapeutic. Only a few cases of intoxication by this drug have been described, but it is known that it has a narrow therapeutic margin (0.5 to 0.8 mg/kg), almost always resulting in fatal results above these limits. Regarding therapeutic management, the initiation of supportive measures is essential. Initial strategies are gastric lavage, administration of activated charcoal and fluid resuscitation aimed at preventing renal failure. Case report: A 63-year-old man with a history of spondylodiscitis and gouty arthropathy, receiving colchicine treatment. He reported abdominal symptoms with nausea, vomiting, watery stools, and diffuse pain after taking 36 tablets of 1 mg of colchicine due to exacerbation of arthralgias (the patient later recognized the autolytic ideation). He was hospitalized in the ICU due to hemodynamic instability, severe pancytopenia, respiratory failure requiring mechanical ventilation and non-oliguric acute renal failure. The patient improved and was discharged from the ICU after 14 days. Conclusions: Colchicine poisoning is rare and has high mortality despite the favorable evolution of our patient. There is no specific treatment at the moment and management should emphasize early admission to the ICU, close monitoring and organ support measures.