Acute Colchicine Intoxication Complicated With Extramedullary Hematopoiesis Due to Filgrastim in a Child

Abstract

Colchicine is a widely used alkaloid extract in children and adults for standard therapy and prophylaxis for amyloid deposition in different rheumatologic disorders. Colchicine intoxication is a rare but severe complication. The aim of this study was to report the extramedullary hematopoiesis as a complication of filgrastim usage in a child with acute colchicine intoxication. Herein, we report a 3-year-old boy with colchicine intoxication associated with neutropenia, disseminated intravascular coagulation, liver injury, and rhabdomyolysis without hepatosplenomegaly. Filgrastim was started at the fourth day of administration for severe neutropenia with fever; 3 days after the start of filgrastim, the patient experienced hepatosplenomegaly with severe leukocytosis (51,110/mm) and myeloid precursors at peripheral blood smear. Bone marrow aspiration was normal; the clinical outcome of the child was eventful without any complication. The clinicians managing colchicine intoxications must be vigilant about the possible side effect of extramedullary hematopoiesis caused by filgrastim used for neutropenia in colchicine intoxication.

Progressive Organ Failure After Ingestion of Wild Garlic Juice

“…Extracorporeal elimination (hemodialysis and hemoperfusion) is ineffective due to the large volume of distribution of colchicine (12). Granulocytestimulating factor may be used to assist regeneration of suppressed bone marrow, but should be stopped early to avoid extramedullary hematopoiesis, especially in children, although specific guidelines do not exist on this topic (13,14). Experimental treatment with colchicine-specific Fab fragments has been successfully used, but has not been tested in randomized controlled studies or on a large group of patients, and is not commercially available (15).…”

Assessment of 17 Pediatric Cases With Colchicine Poisoning in a 2-Year Period

“…One of the cases in the study group (case 14) was a male case aged 3 years previously presented by Kilic et al 16 He received 0.2 mg/kg of colchicine in subtoxic dose and admission was 24 hours after the medication intake. Initial laboratory findings were hyperuricemia, prerenal azotemia, and increase in LDH and CK levels.…”

Clinical, Laboratory, and Electrocardiographic Findings in Colchicine Toxicity: 10 Years of Experience

“…Previous studies on colchicine poisoning are generally case reports and small case series ( 17 – 19 ). The clinical effects of colchicine on different organs are shown in Table 7 .…”

“… Definitions and Measuring Criteria for ECG Variables ( 17 ) . a Calculation for pediatrics were based on normal range for their age .…”