Quality and Patient Safety Articles-Colchicine Toxicity

Colchicine Toxicity

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Colchicine toxicity can cause an underrecognized neuromuscular syndrome involving both myopathy and neuropathy. In the presented case, a 70-year-old man with gout, chronic renal insufficiency, and progressive proximal leg weakness had EMG/NCS findings consistent with irritable myopathy plus sensorimotor axonal polyneuropathy.

The key risk factor for colchicine neuromyopathy is <strong>chronic renal disease</strong>. Reduced renal clearance increases colchicine exposure and toxicity, even at standard doses. Symptoms may develop acutely, subacutely, or chronically, and patients often present with <strong>symmetric proximal weakness</strong> along with <strong>distal sensory loss</strong>. CK may be elevated.

Electrodiagnostic testing typically shows <strong>myopathic motor unit potentials</strong> in proximal muscles, often with <strong>fibrillations or positive sharp waves</strong>, and nerve conduction studies may reveal an <strong>axonal sensorimotor polyneuropathy</strong>. Muscle biopsy classically demonstrates a <strong>vacuolar myopathy</strong> with autophagic vacuoles.

The condition can mimic inflammatory myopathies such as polymyositis, but it usually improves after <strong>stopping colchicine</strong>.

Keywords

colchicine toxicity

neuromyopathy

chronic renal disease

proximal muscle weakness

sensorimotor axonal polyneuropathy

myopathy

neuropathy

electrodiagnostic testing

vacuolar myopathy

stopping colchicine