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Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature

We report the case of a 46-years-old man with long-term asymptomatic hyperuricemia who started taking colchicine (0.5 mg/day) and allopurinol (100 mg/d) for normalization of biochemical values. After the third week of starting treatment, acute weakness was present; and by the fifth week, profound we...

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Autores principales: Fernández-Cuadros, Marcos Edgar, Goizueta-San-Martin, Gabriela, Varas-de-Dios, Blanca, Casique-Bocanegra, Luz Otilia, Manrique-de-Lara-Cadiñanos, Pablo, Albaladejo-Florin, María Jesus, Algarra-López, Ruben, Pérez-Moro, Olga Susana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580718/
https://www.ncbi.nlm.nih.gov/pubmed/31244525
http://dx.doi.org/10.1177/1179544119849883
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author Fernández-Cuadros, Marcos Edgar
Goizueta-San-Martin, Gabriela
Varas-de-Dios, Blanca
Casique-Bocanegra, Luz Otilia
Manrique-de-Lara-Cadiñanos, Pablo
Albaladejo-Florin, María Jesus
Algarra-López, Ruben
Pérez-Moro, Olga Susana
author_facet Fernández-Cuadros, Marcos Edgar
Goizueta-San-Martin, Gabriela
Varas-de-Dios, Blanca
Casique-Bocanegra, Luz Otilia
Manrique-de-Lara-Cadiñanos, Pablo
Albaladejo-Florin, María Jesus
Algarra-López, Ruben
Pérez-Moro, Olga Susana
author_sort Fernández-Cuadros, Marcos Edgar
collection PubMed
description We report the case of a 46-years-old man with long-term asymptomatic hyperuricemia who started taking colchicine (0.5 mg/day) and allopurinol (100 mg/d) for normalization of biochemical values. After the third week of starting treatment, acute weakness was present; and by the fifth week, profound weakness in lower extremities and tenderness and cramps on thighs and calves with inability to climb stairs were also observed. Biochemical evaluation showed elevated muscle enzymes (creatinine kinase [CK] raised to five-folds its normal value) and electromyographic features were consistent with myopathy (at rest, fibrillations, positive sharp waves, high-frequency myotonic discharges; motor unit action potentials [MUAPs] of small amplitude, small duration, increased polyphasic Index and occasional satellite potentials; at maximal effort, interferential recruitment pattern with reduced amplitudes were observed). Normal motor and sensitive nerve conduction studies and normal late F-responses and H-reflex discarded neuropathy. Rapid improvement in muscle strength and prompt resolution of abnormal elevated muscle enzymes was observed after withdrawal of both medications. Colchicine is associated with some cases of myotoxicity but very small cases of colchicine-induced rhabdomyolysis are reported on the literature. Colchicine-induced rhabdomyolysis is related to the concomitant use of drugs (statins, steroids, erythromycin, and cyclosporine), renal, and/or hepatic impairment. To the best of our knowledge, this is an uncommon presentation of a case of colchicine-induced rhabdomyolysis reported in a patient without renal or hepatic dysfunction. Therefore, patients receiving colchicine even in the absence of renal insufficiency should be monitored for the development of myopathy and more rarely to rhabdomyolysis.
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spelling pubmed-65807182019-06-26 Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature Fernández-Cuadros, Marcos Edgar Goizueta-San-Martin, Gabriela Varas-de-Dios, Blanca Casique-Bocanegra, Luz Otilia Manrique-de-Lara-Cadiñanos, Pablo Albaladejo-Florin, María Jesus Algarra-López, Ruben Pérez-Moro, Olga Susana Clin Med Insights Arthritis Musculoskelet Disord Case Report We report the case of a 46-years-old man with long-term asymptomatic hyperuricemia who started taking colchicine (0.5 mg/day) and allopurinol (100 mg/d) for normalization of biochemical values. After the third week of starting treatment, acute weakness was present; and by the fifth week, profound weakness in lower extremities and tenderness and cramps on thighs and calves with inability to climb stairs were also observed. Biochemical evaluation showed elevated muscle enzymes (creatinine kinase [CK] raised to five-folds its normal value) and electromyographic features were consistent with myopathy (at rest, fibrillations, positive sharp waves, high-frequency myotonic discharges; motor unit action potentials [MUAPs] of small amplitude, small duration, increased polyphasic Index and occasional satellite potentials; at maximal effort, interferential recruitment pattern with reduced amplitudes were observed). Normal motor and sensitive nerve conduction studies and normal late F-responses and H-reflex discarded neuropathy. Rapid improvement in muscle strength and prompt resolution of abnormal elevated muscle enzymes was observed after withdrawal of both medications. Colchicine is associated with some cases of myotoxicity but very small cases of colchicine-induced rhabdomyolysis are reported on the literature. Colchicine-induced rhabdomyolysis is related to the concomitant use of drugs (statins, steroids, erythromycin, and cyclosporine), renal, and/or hepatic impairment. To the best of our knowledge, this is an uncommon presentation of a case of colchicine-induced rhabdomyolysis reported in a patient without renal or hepatic dysfunction. Therefore, patients receiving colchicine even in the absence of renal insufficiency should be monitored for the development of myopathy and more rarely to rhabdomyolysis. SAGE Publications 2019-06-17 /pmc/articles/PMC6580718/ /pubmed/31244525 http://dx.doi.org/10.1177/1179544119849883 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Fernández-Cuadros, Marcos Edgar
Goizueta-San-Martin, Gabriela
Varas-de-Dios, Blanca
Casique-Bocanegra, Luz Otilia
Manrique-de-Lara-Cadiñanos, Pablo
Albaladejo-Florin, María Jesus
Algarra-López, Ruben
Pérez-Moro, Olga Susana
Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title_full Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title_fullStr Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title_full_unstemmed Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title_short Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature
title_sort colchicine-induced rhabdomyolysis: clinical, biochemical, and neurophysiological features and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580718/
https://www.ncbi.nlm.nih.gov/pubmed/31244525
http://dx.doi.org/10.1177/1179544119849883
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