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Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol

A 58‐year‐old woman was admitted for heart failure and concern for cardiogenic shock. The patient had been recently placed on colchicine and allopurinol, 4 months and 3 weeks, respectively, prior to admission. Upon admission, she had a cutaneous eruption that had started abruptly several days after...

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Autores principales: Salari, Behzad, Joseph, Mallory, Eshaq, Milad, Lowe, Lori, Fullen, Douglas R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9796373/
https://www.ncbi.nlm.nih.gov/pubmed/35734802
http://dx.doi.org/10.1111/cup.14280
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author Salari, Behzad
Joseph, Mallory
Eshaq, Milad
Lowe, Lori
Fullen, Douglas R.
author_facet Salari, Behzad
Joseph, Mallory
Eshaq, Milad
Lowe, Lori
Fullen, Douglas R.
author_sort Salari, Behzad
collection PubMed
description A 58‐year‐old woman was admitted for heart failure and concern for cardiogenic shock. The patient had been recently placed on colchicine and allopurinol, 4 months and 3 weeks, respectively, prior to admission. Upon admission, she had a cutaneous eruption that had started abruptly several days after allopurinol initiation. It included multiple erythematous papules with scant scale on the forearms and numerous erythematous papules on the legs. Because of the varied morphologic presentation, biopsies from both the thigh and forearm were performed for a suspected drug reaction. The specimen from the thigh showed a superficial‐dermal, band‐like lymphocytic infiltrate with dyskeratosis and numerous intraepidermal mitotic figures predominantly in metaphase. In addition, there were neutrophils with leukocytoclasia. The specimen from the forearm showed superficial perivascular lymphocytic inflammation and intraepidermal dyskeratosis with mitotic figures similar to the thigh biopsy specimen but without a dermal neutrophilic infiltrate. An unusual drug eruption with features of colchicine toxicity was favored. Colchicine toxicity is not a commonly encountered clinical scenario and cutaneous findings have only rarely been described. Herein we report an exceedingly rare case of an unusual drug reaction with “colchicine figures” (i.e., ring‐shaped mitotic figures arrested in metaphase) consistent with colchicine toxicity.
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spelling pubmed-97963732022-12-30 Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol Salari, Behzad Joseph, Mallory Eshaq, Milad Lowe, Lori Fullen, Douglas R. J Cutan Pathol Case Studies A 58‐year‐old woman was admitted for heart failure and concern for cardiogenic shock. The patient had been recently placed on colchicine and allopurinol, 4 months and 3 weeks, respectively, prior to admission. Upon admission, she had a cutaneous eruption that had started abruptly several days after allopurinol initiation. It included multiple erythematous papules with scant scale on the forearms and numerous erythematous papules on the legs. Because of the varied morphologic presentation, biopsies from both the thigh and forearm were performed for a suspected drug reaction. The specimen from the thigh showed a superficial‐dermal, band‐like lymphocytic infiltrate with dyskeratosis and numerous intraepidermal mitotic figures predominantly in metaphase. In addition, there were neutrophils with leukocytoclasia. The specimen from the forearm showed superficial perivascular lymphocytic inflammation and intraepidermal dyskeratosis with mitotic figures similar to the thigh biopsy specimen but without a dermal neutrophilic infiltrate. An unusual drug eruption with features of colchicine toxicity was favored. Colchicine toxicity is not a commonly encountered clinical scenario and cutaneous findings have only rarely been described. Herein we report an exceedingly rare case of an unusual drug reaction with “colchicine figures” (i.e., ring‐shaped mitotic figures arrested in metaphase) consistent with colchicine toxicity. Blackwell Publishing Ltd. 2022-07-12 2022-11 /pmc/articles/PMC9796373/ /pubmed/35734802 http://dx.doi.org/10.1111/cup.14280 Text en © 2022 The Authors. Journal of Cutaneous Pathology published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Case Studies
Salari, Behzad
Joseph, Mallory
Eshaq, Milad
Lowe, Lori
Fullen, Douglas R.
Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title_full Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title_fullStr Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title_full_unstemmed Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title_short Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
title_sort unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol
topic Case Studies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9796373/
https://www.ncbi.nlm.nih.gov/pubmed/35734802
http://dx.doi.org/10.1111/cup.14280
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