Abstract
BackgroundColchicine is used in the treatment and prophylaxis of gout. It possesses a narrow therapeutic window, frequently resulting in dose-limiting gastrointestinal side-effects such as diarrhoea and emesis. As colchicine is a cellular anti-mitotic agent, the most serious effects include myelosuppression, myoneuropathy and multiple organ failure. This occurs with intentional overdose or with therapeutic dosing in patients with reduced clearance of colchicine due to pre-existing renal or hepatic impairment. Acute pancreatitis has rarely been reported, and only in association with severe colchicine overdose accompanied by multi-organ failure.Case presentationWe report a case of acute pancreatitis without other organ toxicity related to recent commencement of colchicine for acute gout, occurring in an elderly male with pre-existing renal impairment.Conclusion1) Colchicine should be used with care in elderly patients or patients with impaired renal function.2) Aside from myelosuppression, myoneuropathy and multiple organ failure, colchicine may now be associated with acute pancreatitis even with therapeutic dosing; this has not previously being reported.
Highlights
Colchicine is used in the treatment and prophylaxis of gout
2) Aside from myelosuppression, myoneuropathy and multiple organ failure, colchicine may be associated with acute pancreatitis even with therapeutic dosing; this has not previously being reported
The incidence of acute pancreatitis varies in different countries and depends on cause, with the estimated incidence in England being 5.4/100 000 per year; in the United States it is 79.8/100 000 per year [14]
Summary
Colchicine is frequently used to treat and prevent recurrence of acute gout [1] but has a narrow therapeutic window, with dose-limiting gastrointestinal side-effects such as diarrhoea and vomiting [2]. A 79 year old man presented to the Emergency Department with severe epigastric pain, nausea, vomiting without hematemesis, diarrhoea and anorexia. He has a history of red cell and platelet transfusion dependent myelofibrosis, iron overload due to multiple red cell transfusion, chronic renal failure, ischemic heart disease, left ventricular systolic dysfunction, cerebrovascular disease, peripheral vascular disease, hypertension, and hyperlipidemia. The patient recovered over 48 hours with clear oral fluids and supportive medical treatment including intravenous fluids and analgesia as required. An abdominal ultrasound demonstrated normal liver texture, oedematous pancreas, and multiple small incidental calculi within a normal walled gallbladder, no hepatobiliary ductal dilatation or pericholecystic fluid, normal pancreatic duct, enlarged spleen and multiple bilateral renal cysts without hydronephrosis
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