Fatal multiple organ dysfunction syndrome induced by colchicine poisoning in a patient with underlying alcoholic liver disease: a case report.

Background: Colchicine is a drug used primarily to treat and prevent gout. Yet its narrow therapeutic index makes the lethal dose highly variable, influenced by patient-specific factors such as hepatic function and concomitant medications. In vulnerable patients, even doses substantially below the traditionally cited lethal threshold can result in fatal outcomes. Case Description: We report a case of a 58-year-old male with a history of gout, alcoholic liver disease, and hyperlipidemia who presented with vomiting, diarrhea, and abdominal pain that lasted three days after ingesting 15 mg of colchicine (0.22 mg/kg) for gout pain relief. Upon admission, laboratory findings revealed acute kidney injury, severe metabolic acidosis, leukopenia, and thrombocytopenia. Despite aggressive supportive care in the intensive care unit (ICU), including broad-spectrum antibiotics, fluid resuscitation, steroids and recombinant human thrombopoietin (rhTPO), the patient developed progressive multiple organ dysfunction syndrome (MODS), disseminated intravascular coagulation (DIC), and spontaneous intracranial hemorrhage. On the eighth day of admission, the family opted to discontinue further organ support, and the patient died shortly thereafter. Conclusions: This case shows that in patients with hepatic impairment, severe colchicine toxicity and fatal outcomes may occur even at doses below the traditionally cited threshold. The case also demonstrates that it is critical for physicians to be alert to the serious adverse effects of inadvertent colchicine overdose when prescribing the drug.