title: Colchicine-related death presenting as an unknown case of multiple organ failure.
abstract: A 45-year-old man presented to the emergency department (ED) with acute renal and hepatic failure as well as hypotension and metabolic acidosis. Despite aggressive intensive care, he had continued hypotension, leukocytosis, fever, renal and hepatic failure, and lactic acidosis. On hospital day 3, pancytopenia was noted. Bone marrow biopsy showed marked aplasia without a specific etiology being elucidated. He received granulocyte colony-stimulating factor and antibiotics, but died on hospital day 12 after a cardiac arrest. The patient repeatedly denied intentional drug ingestion. Due to his clinical course, the poison center recommended obtaining a colchicine level. The plasma colchicine level, 72 h after admission, was 6.1 ng/mL (GC/MS). This level exceeds acute levels reported in some cases of prior fatalities. This case is novel in that the patient's multiple organ dysfunction remained unexplained for several days before occult colchicine toxicity was implicated as the probable cause by the colchicine level. Also, there was a paucity of gastrointestinal symptoms on presentation, the opposite of what is expected in colchicine toxicity.
authors.affiliation: Department of Emergency Medicine, Darnall Army Community Hospital, Ft. Hood, Texas 76544, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Miller
authors.forename: Yao-Min
authors.initials: YM
authors.lastname: Hung
authors.forename: Christine
authors.initials: C
authors.lastname: Haller
authors.forename: Mark
authors.initials: M
authors.lastname: Galbo
authors.forename: Marc E
authors.initials: ME
authors.lastname: Levsky
mesh_terms: D001855:Bone Marrow Diseases / Q000139:chemically induced; D003078:Colchicine / Q000506:poisoning*; D062787:Drug Overdose / Q000175:diagnosis; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced*; D010198:Pancytopenia / Q000139:chemically induced
chemical_list: D003078:Colchicine