Colchicine-induced leukopenia in a patient with familial Mediterranean fever: The cause and a possible approach

A young patient with familial Mediterranean fever (FMF) developed leukopenia each time she took colchicine. However drug the when she discontinued the white cell and the platelets counts increased but she experienced FMF attacks. Later it was found that the patient also had concomitant cytomegalovirus (CMV) infection. This complex situation posed several diagnostic and therapeutic issues concerning the real cause for the leukopenia and the possible approach to take in such conditions. We propose that when an essential drug (such as colchicine for FMF) causes leukopenia, one should look for concurrent CMV or another viral infection. If there is no such infection, it is suggested that the mechanism leading to leukopenia be clarified. In the case of bone marrow suppression, colchicine should be continued with injections of G-CSF whereas if the bone marrow is hypercellular it is suggested to use steroids and colchicine concomitantly.