Extremely High-Dose Colchicine Intoxication With Neurological Complications: A Survival Case Report

Familial Mediterranean fever (FMF) is an autoinflammatory disease with autosomal recessive inheritance, associated with mediterranean fever gene mutation, characterized by recurrent episodes of fever, serositis, and arthritis. Colchicine is the gold standard treatment but has a narrow therapeutic index. A 19-year-old male with FMF presented with abdominal pain, weakness, nausea, and vomiting after accidental ingestion of approximately 100 colchicine tablets in a suicide attempt. He developed multi-organ dysfunction, including acute kidney injury (creatinine: 2.33 mg/dL), hepatotoxicity (aspartate aminotransferase: 678 U/L), rhabdomyolysis (creatine kinase: 9996 U/L), and severe pancytopenia (white blood cell count: 710/μL, platelet count: 15,000/μL). Neurological complications included decreased consciousness, apathetic speech, and ataxia. The patient was managed in the intensive care unit with aggressive supportive therapy including intravenous hydration, broad-spectrum antibiotics, and granulocyte colony-stimulating factor (filgrastim) for bone marrow suppression. After 4 days, pancytopenia resolved, and organ functions gradually improved. The patient made a complete recovery. This case demonstrates that survival is possible even after extremely high-dose colchicine ingestion with appropriate supportive care. Close monitoring and patient education are crucial in FMF management to prevent toxicity.