Death Following Colchicine Poisoning

Abstract

A 45-year-old male was admitted to hospital after 2 to 3 days of vomiting, nausea, and diarrhea following an apparent overdose of colchicine tablets. During hospitalization his white blood cell count fell dramatically. At death, 33 h following initial hospitalization, pleural effusion with bilateral bronchopneumonia was evident, together with numerous bacterial colonies and marked hypocellularity of bone marrow and reduced megakaryocytes, erythroid, and myeloid cells. The most striking histological findings were numerous metaphasic mitotic figures in gastric and small bowel epithelia. Colchicine was detected, confirmed by high pressure liquid chromatography with photodiode array detection, and quantitated in antemortem plasma collected 3.3 h following hospitalization and in postmortem blood and bile. Colchicine was not detected in liver, vitreous humor, or stomach contents.

Colchicine poisoning: case report of two suicides

“…Nevertheless, few-symptomatic cases of colchicine poisonings are reported: Danel et al [7] and Guven et al [16] point to the confirmation of the diagnosis by toxicological analysis. Several papers pointed that even after massive overdose, it could be impossible to detect colchicine in blood, and as there is a widespread enterohepatic recirculation before excretion, bile appears to be the target sample to analyze in case of negative results in blood, especially if death occurs many hours after colchicine intake and often after hospitalization [1,5,6,8,10,19]. We found also that bile is a sample of great interest because of the high concentration level of colchicine.…”

“…Homicidal deaths are extremely rare [9]. Self-poisoning by colchicine occur by ingestion of medications used in acute gouty arthritis, recurrent gouty attacks, amyloid deposition in familial Mediterranean fever, primary biliary cirrhosis [4,10,11]. In France, colchicine is only available as 1 mg tablets, alone (Colchicine Houdé 1 , Hoechst-Houdé, Paris, France) or in addition with 50 mg tiemonium and 12.5 mg opium powder to counteract the diarrhea due to colchicine (Colchimax 1 , Hoechst-Houdé, Paris, France).…”

Detection of colchicine by means of LC-MS/MS after mistaking meadow saffron for bear's garlic

“…Hence, a quantitative assessment of colchicine in the postmortem blood is often either not possible (17), or the measured concentrations are very low. The colchicine concentrations in postmortem blood reported in the literature range between 13 ng/mL and 66 ng/mL (18)(19)(20)(21) ( Table 1). The concentrations measured in the present cases in the heart blood were of the same magnitude (36.6 ng/mL or 98.3 ng/mL), although femoral blood is the more suitable investigation material owing to redistribution.…”

“…If toxicological proof of a colchicine poisoning fails for reasons just cited, histological investigations can produce a diagnosis of colchicine intoxication (14,16,18). Because of the inhibition of the protein polymerization necessary for spindle formation during cell division, mitosis stops in the metaphase.…”

Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning

“…Various alterations of the gastrointestinal mucosa associated with fatal poisoning by orally ingested substances are well known including for example discolouration by chromate compounds [1], oedema and diffuse gastric hemorrhage following mercury oxycyanide ingestion [2], gastritis caused by chloralhydrate overdose and mercuric compounds [3,4], erosion following benzalkonium chloride poisoning [5] and metaphasic mitotic figures in gastric and small bowel epithelium due to colchicine poisoning [6]. Additionally, suspicious gastric contents, e.g.…”