Fatal poisoning with colchicum autumnale: A case report

Colchicum autumnale is commonly known as the autumn crocus, wild saffron and naked lady. In local language here in southern Karnataka, it is known as gowri gedde. It contains alkaloid colchicine that is antimitotic, blocking the mitosis by preventing DNA synthesis and tubulin polymerization. The clinical manifestation of colchicine poisoning is present in three phases following a latent period of 4-12 hours. The first phase is characterized by peripheral leukocytosis, gastrointestinal symptoms with fluid losses and hypovolemic shock. During 24-72 hours, the second stage of intoxication, life threatening complications occur such as arrhythmias, heart failure, renal failure, hepatic injury, respiratory distress, coagulopathies, bone marrow suppression and neuromuscular involvement. Second phase usually lasts for 5-7 days. Third phase is characterized by leukocytosis and alopecia. Colchicine is rapidly absorbed from the gastrointestinal tract and is primarily metabolized in the liver in a first order process. There is also significant biliary excretion and enterohepatic recirculation. Renal excretion is only responsible for about 20% of unchanged colchicine elimination. We present here a case of fatal poisoning with colchicum autumnale in a middle aged lady who finally succumbed to death due to multi-organ dysfunction.