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Colchicine is a unique anti-inflammatory agent that has been therapeutically used in acute gout for over 230 years. 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 myoneuropathy 2 and myotonia 3 especially in the presence of renal impairment. Rhabdomyolysis induced by colchicine is however rare. Herein we report a case of rhabdomyolysis associated with colchicine use in a patient suffering from gout.
Case report
A 73 year old man presented with a three week history of increasing shortness of breath, nausea, and diffuse muscle aches and pains. He had had ischaemic heart disease and atrial fibrillation for six years and chronic gout for five years. For six weeks before presentation he had been taking an increased dose of colchicine (1.5 mg daily) for an exacerbation of gouty arthritis. He had taken the drug in a lower dose (0.5-1 mg a day) on an occasional basis since the onset of his gout for a previous exacerbation. Other medications (with duration of ingestion) included digoxin 125 [mu]g (six years), allopurinol 300 mg (four years), frusemide (furosemide) 160 mg (three years), lisinopril 20mg (one year), isosorbide mononitrate 60 mg (one year), and warfarin 3 mg (six months) all once daily and metolazone 2.5 mg twice a week (six months). He had no known muscle or renal diseases and consumed fewer than 10 units of alcohol a week.
Clinically, he was in controlled atrial fibrillation with moderate congestive cardiac failure. He had tender deltoid and thigh muscles, proximal muscle weakness (grade 4/5 power) in both the upper and lower limbs, and generalised hyporeflexia. The sensory system and coordination were intact. There was no rash or lymphadenopathy.
He had a grossly raised serum creatine kinase (36200...