Leukopenia associated with long-term colchicine administration.

Area of Science:

• Hematology
• Rheumatology
• Pharmacology

Background:

• Calcium pyrophosphate dihydrate (CPPD) deposition disease, or pseudogout, is a crystal-induced arthropathy.
• Colchicine is a medication commonly used for the prophylaxis and treatment of gout and pseudogout.
• Chronic lymphocytic leukemia (CLL) is a type of cancer affecting lymphocytes.

Observation:

• An 85-year-old male patient with a history of CLL, pseudogout, osteoarthritis, and hypertension developed leukopenia.
• The patient was receiving colchicine for pseudogout prophylaxis, and his white blood cell (WBC) and absolute neutrophil count (ANC) decreased significantly.
• Despite colchicine dose reduction, leukopenia persisted, necessitating filgrastim administration and colchicine discontinuation.

Findings:

• Colchicine administration was temporally associated with severe leukopenia in a patient with CLL.
• The patient's WBC and ANC counts improved after colchicine discontinuation and administration of filgrastim and pegfilgrastim.
• Reintroduction of colchicine led to a recurrence of leukopenia, indicating a likely drug-induced etiology.

Implications:

• This case highlights a potential adverse effect of colchicine in patients with underlying hematological conditions like CLL.
• Close monitoring of blood counts is crucial for patients with CLL receiving colchicine, especially for pseudogout.
• The findings suggest a need for careful consideration of colchicine use and potential drug interactions in patients with compromised bone marrow function.