Colchicine is an anti‐inflammatory drug commonly used for the treatment of gouty arthritis, Behçet's disease and amyloidosis. Reported side effects, such as blood dyscrasias and gastroenteritis, are probably ascribed to its antimitotic properties. Colchicine‐induced myopathy with vacuolar changes and frequently associated sensory‐motor axonal neuropathy have also been described. A 52‐yr‐old woman, previously treated for gouty arthritis, persisted in self‐administering colchicine intermittently for three years, in order to reduce body weight by inducing diarrhea. The patient had weakness and hypotrophy in upper and lower girdles and proximal muscles, “stocking and glove” hypoesthesia and loss of deep tendon reflexes in lower limbs. EMG examination showed a neurogenic/myogenic mixed pattern and nerve conduction studies were consistent with sensory‐motor axonal polyneuropathy. Muscle biopsy showed a vacuolar myopathy, with autophagic vacuoles and associated neurogenic changes. A moderate loss of myelinated fibers and some degenerating axons were observed in sural nerve biopsy. There were neither demyelinating changes nor autophagic vacuoles within axons. Muscle and nerve findings were thus suggestive of colchicine neuromyopathy. The drug was withdrawn and clinical‐electrophysiological data improved. Colchicine muscular toxicity is presumably due to inhibition of tubulin monomer polymerization. The microtubular network destabilization might cause cytoplasmic deposits of autophagic debris in skeletal muscle. We thus evaluated number, density and spatial array of microtubules in myelinated and unmyelinated axons by transmission electron microscopy. Quantitative ultrastructural analysis was carried out on high magnification photographs in our patient biopsy and in control nerves (normal and with axonal loss). Decrease of microtubular density and increase of tangentially oriented microtubules were observed both in myelinated and unmyelinated axons. No neural deposits of tubulin‐like material, as described in some cases of colchicine myopathy, were found. As in experimental vincristine neuropathy, cytoskeletal damage induced by colchicine seems related to effects of primary microtubular disarray on axonal transport and caliber, rather than to the extent of axonal loss.