Acute poisoning with autumn crocus (Colchicum autumnale L.)
Tóm tắt
Colchicum autumnale, commonly known as the autumn crocus or meadow saffron, contains the antimitotic colchicine, which binds to tubulin and prevents it forming microtubules that are part of the cytoskeleton in all cells. A 71-year-old woman ate a plant she thought to be wild garlic (Allium ursinum). Ten hours later she arrived at the emergency department complaining of nausea, vomiting and watery diarrhea. Ingestion of a poisonous plant was suspected and she was treated with gastric lavage, oral activated charcoal and an infusion of normal saline. Toxicology analysis with gas chromatography and mass spectrometry revealed colchicine in the patient’s gastric lavage, blood (5 μ/l) and urine (30 μ/l). She developed arrhythmias, liver failure, pancreatitis, ileus, and bone marrow suppression with pancytopenia. Alopecia began in the third week. Treatment was supportive only. Five months later she had no clinical or laboratory signs of poisoning. The patient mistakenly ingested autumn crocus instead of wild garlic because of their great similarity. Colchicine primarily blocks mitosis in tissues with rapid cell turnover; this results in gastroenterocolitis in the first phase of colchicine poisoning, bone marrow hypoplasia with pancytopenia in the second and alopecia in the third, all of which were present in our patient. Colchicine toxicity in tissues without rapid cell turnover caused arrhythmias, acute liver failure and pancreatitis. Colchicine poisoning can result in gastroenterocolitis followed by multi-organ dysfunction syndrome. In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice, especially when wild garlic is mentioned, we should always consider autumn crocus. Diagnosis could be confirmed only by toxicology analyses. Management of colchicine poisoning is restricted to supportive therapy.
Tài liệu tham khảo
Brncic N, Viskovic I, Peric R, Dirlic A, Vitezic D, Cuculic D (2001) Accidental plant poisoning with Colchicum autumnale: report of two cases. Croat Med J 42: 673–675
Folpini A, Furfori P (1995) Colchicine toxicity-clinical features and treatment. Massive overdose case report. J Toxicol Clin Toxicol 33: 71–77
Donovan JW (1999) Nonsteroidal anti-inflammatory drugs and colchicine. In: Haddad LM, Shannon MW, Winchester JE (eds) Clinical management of poisoning and drug overdose. 3rd edn. Saunders, Philadelphia. pp 687–699
Clevenger CV, August TF, Shaw LM (1991) Colchicine poisoning: report of a fatal case with body fluid analysis by GC/MS and histopathologic examination of postmortem tissues. J Anal Toxicol 15: 151–154
Sabouraud A, Rochdi M, Urtizberea M, Christen MO, Achtert G, Scherrmann JM (1992) Pharmacokinetics of colchicine: a review of experimental and clinical data. Z Gastroenterol 30: 35–39
Rudi J, Raedsch R, Gerteis C, Schlenker T, Plachky J, Walter-Sack I, Sabouraud A, Scherrmann JM, Kommerell B (1994) Plasma kinetics and biliary excretion of colchicine in patients with chronic liver disease after oral administration of a single dose and after long-term treatment. Scand J Gastroenterol 29: 346–351
Bain L, Galloway D, Petrie J, Wood R (1974) Gout. Br Med J 1: 446–448
Wallace SL, Omokoku B, Ertel NH (1970) Colchicine plasma levels. Implications as to pharmacology and mechanism of action. Am J Med 48: 443–448
Danel VC, Wiart JF, Hardy GA, Vincent FH, Houdret NM (2001) Self-poisoning with Colchicum autumnale L. flowers. J Toxicol Clin Toxicol 39: 409–411
Bismuth C, Baud F, Dally S (1986) Standardized prognosis evaluation in acute toxicology: its benefit in colchicine, paraquat, and digitalis poisonings. Journal de Toxicologie Clinique et Experimentale 6: 33–38
Hofer JF, Franz B, Holzinger G (1992) Familial Mediterranean fever. Case of a 48-year-old patient with recurrent abdominal pain. Wien Klin Wochenschr 104: 208–210
Eddleston M, Persson H (2003) Acute plant poisoning and antitoxin antibodies. J Toxicol Clin Toxicol 41: 309–315
Critchley JA, Critchley LA, Yeung EA, Young RP, Young RJ, Chan TY, Goh VK (1997) Granulocyte-colony stimulating factor in the treatment of colchicine poisoning. Hum Exp Toxicol 16: 229–232
Borisy GG, Taylor EW (1967) The mechanism of action of colchicine. Binding of colchincine-3H to cellular protein. J Cell Biol 34: 525–533
Harris R, Marx G, Gillett M, Kark A, Arunanthy S (2000) Colchicine-induced bone marrow suppression: treatment with granulocyte colony-stimulating factor. J Emerg Med 18: 435–440
Yamada M, Nakagawa M, Haritani M, Kobayashi M, Furuoka H, Matsui T (1998) Histopatological study of experimental acute poisoning of cattle by autumn crocus (Colchicum autumnale L.) J Vet Med Sci 60: 949–952
Putterman C, Ben-Chetrit E, Caraco Y, Levy M (1991) Colchicine intoxication: clinical pharmacology, risk factors, features, andmanagement. Semin Arthritis Rheum 21: 143–155
Stahl N, Weinberger A, Benjamin D, Pinkhas J (1976) Fatal colchicine poisoning in a boy with familial Mediterranean fever. Am J Med Sci 278: 77–81