Colchicine intoxication mimicking an acute surgical abdomen: report of a pediatric observation

Abstract

Colchicine is an alkaloid extracted from Colchicum autumnale and Gloriosa superba [1]. It is an antimitotic agent belonging to the family of spindle poisons used in several inflammatory diseases like gout and Behcet's disease. Poisonings have been exceptionally reported in children [2]. Here, we describe an unusual colchicine poisoning in a young girl mimicking an acute surgical abdomen.A 14 year-old girl, treated for Behcet's disease with colchicine, was referred for acute diarrhea and abdominal pain. She was conscious, afebrile, with the following vital signs: blood pressure: 92/58 mmHg, heart rate: 130 /min, respiratory rate: 22/min, and SpO2: 98% on room air. There was a slight abdominal guarding. Pulmonary and cardiac examinations were unremarkable. Peripheral pulses were symmetrical. Abdominal X-ray did not reveal pneumoperitoneum. Ultrasound examination showed no peritoneal effusion. Despite supportive management and ceftriaxone + metronidazole combination, her abdominal pain worsened and vomiting started. The patient was admitted to the operating room. Midline laparotomy found a few milliliters of peritoneal fluid. Peritoneal lavage with warm isotonic saline was performed. No significant surgical abnormality was observed. The patient was admitted to the pediatric intensive care unit (ICU). Weaning from mechanical ventilator was impossible because of persistent hypoventilation. She developed a progressive paralysis of lower and upper limbs as well as loss of deep tendon reflexes, in the absence of hypokalemia and rhabodmyolysis. Electromyography was normal. Bacteriological cultures were negative. Alopecia appeared on day 2 and pancytopenia was further assessed (platelets: 1 G/L, hemoglobin: 7 g/dl, and white blood cells: 2 G/L) with no abnormal coagulation test. Diagnosis of colchicine poisoning was suspected. Spontaneous neurological recovery was progressive allowing extubation on day 7. The patient disclosed having ingested 24 mg of colchicine (0.6 mg/kg) for a suicidal attempt following an argument with her family. She left the hospital on day 15 after full recovery with a psychiatric follow-up.Colchicine poisoning is rare in the western countries, representing 0.7% of all intoxications, but more common in the Mediterranean countries because of its wide prescription for periodic disease [2,3]. Colchicine is a soluble alkaloid, absorbed by the ileum, and partially metabolized by the liver cytochrome P450 3A4. Metabolites are excreted in the bile, while one fifth of colchicine is excreted in its active form by the kidneys [3]. Colchicine acts by binding reversibly to tubulin (half life: 20 hours), preventing its polymerization into microtubules, which blocks the mitotic spindle and interrupts cell proliferation [4,5]. Thus, colchicine toxicity mainly involve cells with rapid turnover including the gastro-intestinal (GI) epithelium and bone marrow cells [6].To our knowledge, the youngest reported colchicinepoisoned patient in the literature was 3-year old [7]. Only one fatal case in children has been repor...