Histopathologic features of colchicine toxicity in the gastrointestinal tract, a review of 6 cases

Abstract

Background: Colchicine is an alkaloid drug predominantly used in the treatment and prevention of gout. It has a narrow therapeutic index and toxicity may be associated with gastrointestinal symptoms. Characteristic histopathologic features may be identified in gastrointestinal biopsies. Aim: To describe the histopathologic features of colchicine toxicity in the gastrointestinal tract. Methods: Cases were identified using a database search at Envoi Pathology (2007–2019). Demographic data, clinical history, endoscopic features and histopathologic findings (presence of acute and chronic inflammation, ring mitoses and apoptosis) were documented. Results: Thirteen gastrointestinal biopsies from six patients on oral colchicine therapy were included for analysis. Five patients were male and one was female. The mean patient age was 66 years (range 31–79). Treatment was for gout (n=5) and pericarditis (n=1). Two patients presented with symptoms of colchicine toxicity, including severe diarrhoea (n=1), nausea and abdominal pain (n=1). Four patients did not have clinically suspected colchicine toxicity. Histopathologic features included ring mitoses and chronic inflammation with eosinophils in all biopsies. Crypt apoptosis was present in four cases with associated neutrophils in one case. Conclusion: Colchicine toxicity is characterised by distinct histopathologic features in gastrointestinal biopsies and may be an incidental finding in patients without clinical symptoms.