LAUSR

A 16-year-old girl presented with complaints of vomiting and diarrhea 4 hours after receiving 40 (0.34mg/kg) of 0.5mg colchicine tablets for suicide. Her past medical history revealed that she had been diagnosed with familial mediterranean fever (FMF) and had been on regular followup with daily colchicine treatment. The patient was admitted to the pediatric intensive care unit with a diagnosis of colchicine intoxication. She developed rhabdomyolysis and acute pancreatitis on the first day of follow-up, thrombocytopenia on the second day, and pancytopenia (white blood cells, 2.8×109/L; neutrophils, 2.10×109/L; hemoglobin, 10.8 g/dL; and platelets, 23×109/L) on the fifth day. Peripheral blood smear showed small-sized dysplastic granulocytes with highly hyposegmented bizarre-shaped nuclei and cytoplasms containing fine granules, nuclear fragments, and occasional vacuolization (Fig., Supplemental Digital Content 1, http:// links.lww.com/JPHO/A292). Supportive treatment was given, and her clinical status and laboratory abnormalities resolved gradually. On her ninth day of hospitalization, complete blood count revealed white blood cells of 11.2×109/L, neutrophils of 6.8×109/L, hemoglobin of 13.6 g/dL, and platelets of 287×109/L. Peripheral blood smear showed more segmented normal-sized granulocytes. She gained full recovery and was discharged from the hospital thereafter. Intentional colchicine intoxication caused transient pancytopenia and granulocyte abnormalities in this patient. Colchicine is a drug used in the treatment of many diseases including FMF, gout, amyloidosis, and Behçet disease. It shows its anti-inflammatory effect by inhibiting the activity and movements of neutrophils. Colchicine binds to intracellular tubulin protein in rapidly dividing cells, as in the gastrointestinal system and bone marrow, and interferes with microtubule formation by preventing polymerization.1–5 Acute intoxication with colchicine is not a common condition, but it can cause a severe clinical picture that extends from gastrointestinal and hematologic abnormalities to cardiogenic shock and eventually death.6 At toxic doses, disruption of the microtubular network leads to impairment of many cellular processes including protein assembly in the Golgi apparatus, cell division, endocytosis, exocytosis, cellular motility, and maintenance of cell shape.1 As a result, toxic effects of colchicine in the hematopoietic system leads to bone marrow suppression, granulocyte abnormalities, and eventually pancytopenia.1–5 Hematologic toxicity is first observed between 2 and 6 days of colchicine intoxication and usually lasts 7 to 10 days, as in our patient.1,6 Pancytopenia and hyposegmented bizarre-shaped small-sized granulocytes are the findings of hematologic toxicity of colchicine that correlate well with the clinical status of the patient.