Myoedema: a forgotten sign in acute colchicine myopathy

Abstract

Colchicine myopathy typically presents acutely to subacutely with progressive limb weakness. The patients may not be on high doses of colchicine but almost always have acute kidney injury. Dehydration from colchicine-induced diarrhoea is often a precipitating factor. The concomitant neurotoxicity may produce mild sensory complaints. This combination of acute neurological symptoms preceded by diarrhoea prompts the diagnosis of Guillain-Barre syndrome (GBS). The absence of cranial nerve deficits, raised creatine kinase and myotonic discharges on electromyogram may help in differentiating this condition from GBS. We describe a clinical sign, myoedema — a mounding phenomenon of muscle that is elicited by percussion and resolves when the patient recovers. It aids in the bedside diagnosis of acute colchicine myopathy as well as distinguish it from other more common causes of acute flaccid paralysis. We also discuss the possible mechanism of colchicine toxicity and the mounding phenomenon.

Guillain‐Barré syndrome: a comprehensive review

“…Rhabdomyolysis and fever are common in viral myositides but rare in GBS. Acute colchicine myopathy often manifests with rapidly progressive weakness preceded by diarrhoea; however, the lack of cranial nerve involvement, raised creatine kinase, and the finding of myotonic discharges on electromyography help in differentiating it from GBS [65].…”