Granulocyte-colony stimulating factor in the treatment of colchicine poisoning

Abstract

1 Colchicine is a highly active alkaloid used in the treatment of gouty arthritis and pseudogout. In over dose colchicine inhibits cell division effecting organs with a high rate of cell turn-over, such as the gastrointestinal tract and bone marrow. Early fatality results from cardiovascular collapse and respiratory failure, however pancytopenia and overwhelming septicaemia can occur later.

2 We describe a case of suicidal ingestion of 25 - 30 mg of colchicine in a previously healthy 43-year-old woman. Initial symptoms were mainly gastrointestinal. By day 5 she had developed severe pancytopenia and early sepsis, which were successfully treated using granu locyte colony stimulating factor (G-CSF) 600 μg s.c.

3 In vitro G-CSF is produced by the haematopoietic system. However, G-CSF can now be produced by recombinant DNA cloning technology and thus is available clinically.

4 There is no recognised antidote for colchicine poison ing and treatment is symptomatic. Fab fragments may have a promising future in eliminating colchicine from the body, but are currently not clinically available. In those patients that survive the initial phase of poisoning, G-CSF offers an effective method of treating the pancytopenia and preventing overwhelming septi caemia. Daily monitoring of the patient's haematolo gical status is strongly recommended.