Colchicine-Induced Hepatotoxicity

Abstract

Drug-induced injury (DILI) is a frequent cause of abnormal liver tests and a leading cause of liver failure in the United States. Colchicine has long been used as a systemic anti-inflammatory agent for treatment of gout by inhibiting mitotic activity and neutrophil function. We present the first case of colchicine-induced hepatoxicity, supported by histopathologic findings characteristic of colchicine-induced injury and resolution of liver enzyme abnormalities after its discontinuation. Colchicine-associated DILI has implications for the evaluation of patients with abnormal liver tests and gout, especially for patients with alcoholism and non-alcoholic fatty liver disease, in whom there is an increased incidence of gout.

Figure 1

(A) Histological features of liver biopsy, showing significant anisonucleosis, mild liver cell plate disarray, loss of nuclear polarity, hepatocytes and glycogenated nuclei, and focal macrovesicular steatosis (hematoxylin and eosin stain, 40× magnification). (B) Frequent mitotic figures (arrow) (hematoxylin and eosin stain, 40x magnification). (C) Trichrome stain highlighting peri-centrovenular fibrosis (40× magnification). (D) Trichrome stain highlighting peri-sinusoidal/peri-hepatocellular fibrosis (40× magnification).