Myotonia in colchicine myoneuropathy

Rutkove, Seward B.; Girolami, Umberto De; Preston, David C.; Freeman, Roy; Nardin, Rachel; Gouras, Gunnar K.; Johns, Donald R.; Raynor, Elizabeth M.

doi:10.1002/(sici)1097-4598(199607)19:7<870::aid-mus9>3.0.co;2-6

Cited by 41 publications

(19 citation statements)

References 16 publications

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“…10,11 The syndrome PFMS is a form of myalgia that may occur in patients who have FMF, and is characterized by severe paralyzing myalgia, high fever, abdominal pain, diarrhea, arthritis or arthralgia, and transient vasculitic rashes mimicking Henoch-Schönlein purpura. [12][13][14][15][16][17][18][19][20] The earliest description of PFMS in patients who have FMF was in 1994, and PFMS has been reported in sporadic case reports and 11% patients who have FMF. 12,14 The 5 Mediterranean fever gene (MEFV) mutations of the M694V gene may cause FMF and frequently occur in Arabs.…”

Section: Introductionsupporting

confidence: 90%

“…[14][15][16][17][18][19][20] It is associated with acute attacks of FMF and elevation of serum markers of systemic inflammation such as leukocytosis with predominant neutrophils and elevated erythrocyte sedimentation rate, β2-microglobulin, C-reactive protein, serum amyloid protein, and fibrinogen levels. The PFMS may persist for several weeks and involve the abdominal muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Myotonic discharges may be noted and may correlate with clinical findings of myotonia. 17,18 Muscle biopsy may shows vacuolar changes in muscle cells that are seen best on frozen section because the vacuoles may be damaged by paraffin fixation. Special stains and electron microscopy may confirm that the vacuoles originate from lysosomes.…”

Section: Discussionmentioning

confidence: 99%

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Halim¹,

Al-Otaibi²,

Donia³

et al. 2015

Exp Clin Transplant

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Drug-induced toxic myopathy is a complication of familial Mediterranean fever in patients who receive colchicine, especially when combined with cyclosporine. Protracted febrile myalgia syndrome is a severe form of familial Mediterranean fever. A 34-year-old man who had familial Mediterranean fever for > 15 years developed kidney failure because of secondary amyloidosis. He received livingunrelated-donor kidney transplant that functioned normally. He was on colchicine prophylaxis that was continued after transplant, and he received immunosuppression induction with antithymocyte globulin and maintenance with prednisolone, mycophenolate mofetil, and cyclosporine. After 2 months, he presented with severe myopathy and elevated creatine kinase. Muscle biopsy showed evidence of drug-induced toxic myopathy, most likely caused by cyclosporine in combination with colchicine. Cyclosporine was replaced with sirolimus and colchicine was stopped. Symptoms partially improved and creatine kinase decreased to normal. The prednisolone dosage was reduced gradually to 5 mg daily. At 8 months after transplant, he was readmitted because of severe arthralgia, prolonged fever, pleuritic chest pain, diffuse abdominal pain, purpuric rash, macroscopic hematuria, proteinuria, and diarrhea. The C-reactive protein and erythrocyte sedimentation rate were elevated. The clinical diagnosis was recurrent familial Mediterranean fever presenting as protracted febrile myalgia syndrome. Despite the history of toxic myopathy, he was restarted on colchicine (0.5 mg, twice daily), and colchicine was well tolerated. There was marked improvement of most symptoms within several days. Follow-up 5 years later showed normal kidney graft function and no familial Mediterranean fever activity on colchicine prophylaxis. In summary, familial Mediterranean fever reactivation and protracted febrile myalgia syndrome after kidney transplant may be treated with colchicine and modulation of immunosuppressive therapy.

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Section: Introductionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Halim¹,

Al-Otaibi²,

Donia³

et al. 2015

Exp Clin Transplant

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“…The adverse effects of the drug range from nausea, vomiting, diarrhoea, and abdominal pain to agranulocytosis, aplastic anaemia, and alopecia 1. Colchicine has been reported to cause myoneuropathy2 and myotonia3 especially in the presence of renal impairment. Rhabdomyolysis induced by colchicine is however rare.…”

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confidence: 99%

Colchicine induced rhabdomyolysis

Chattopadhyay

Shetty

Routledge

et al. 2001

Postgraduate Medical Journal

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A case of colchicine induced rhabdomyolysis is reported. A 73 year old man with ischaemic heart disease, atrial fibrillation, chronic congestive cardiac failure, and chronic gout presented with diVuse muscle pain. He had been taking an increased dose of colchicine (1.5 mg daily) for an exacerbation of gout for six weeks before the presentation. Investigations confirmed the diagnosis of rhabdomyolysis and discontinuation of colchicine resulted in resolution of clinical and biochemical features of rhabdomyolysis. Although neuromuscular adverse eVects of colchicine are well recognised, rhabdomyolysis is rare and this is only the fourth reported case of colchicine induced rhabdomyolysis in the literature. (Postgrad Med J 2001;77:191-192)

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“…Needle EMG shows a proximal myopathic and distal neuropathic pattern and may include myotonic discharges. 20 Serum CK levels vary from mildly to markedly elevated. Muscle pathology shows a vacuolar pattern.…”

Section: Antimicrotubular Myopathies Colchicinementioning

confidence: 99%

Drug-Induced Myopathies

Bromberg

2005

Journal of Clinical Neuromuscular Disease

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The incidence of drug-induced myopathic disorders is unknown. Estimates depend in part on definitions used. Cholesterol-lowering agents have been singled out as common offenders. However, the large number of available drugs, polypharmacy especially among the elderly, and known risk factors make the incidence of mild muscle disorders likely more common than suspected, but severe myopathies are likely rare. This article considers factors contributing to drug-induced myopathies and reviews examples of offending drugs.

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Myotonia in colchicine myoneuropathy

Cited by 41 publications

References 16 publications

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Colchicine induced rhabdomyolysis

Drug-Induced Myopathies

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