De Deyn P P, Ceuterick C, Saxena V, Crols R, Chappel R, Martin J J
Dept. of Neurology, General Hospital Middelheim, Antwerp, Belgium.
Acta Neurol Belg. 1995;95(1):29-32.
The presented case concerns a 77-year old man who had been chronically taking colchicine for treatment of gout. He was admitted because of a transient ischemic cerebrovascular attack with motor aphasia and complained of preexisting paraesthesias in the lower extremities. Neurological examination revealed a global muscular weakness, absent myotatic reflexes and a diminished sensation. Serum creatine kinase (CK) levels were increased and electromyography showed spontaneous fibrillations in deltoid muscles, positive spikewaves in deltoids and anterior tibial muscles. Motor and sensory conduction velocities were mildly reduced. Nerve biopsy findings were compatible with a chronic axonal neuropathy having produced a significant loss of myelinated axons and also denervation features of unmyelinated axons. In muscle, combined neurogenic and myogenic features were found. The former result from the axonal neuropathy. The latter were mainly characterized by focal myofibrillar disorganisation and accumulation of autophagic vacuoles in muscle fibres. The presented neuromuscular symptoms and signs, the increased CK values, the electromyographic and nerve conduction velocity findings as well as nerve and muscle biopsy observations, are consistent with the diagnosis of colchicine-induced myopathy and neuropathy. Furthermore, the disappearance of paraesthesias, normalisation of CK values, and disappearance of fibrillations and positive spike waves in deltoid and anterior tibial muscles on electromyography, after stopping of the colchicine therapy, supported the diagnosis.
该病例为一名77岁男性，长期服用秋水仙碱治疗痛风。他因短暂性缺血性脑血管发作伴运动性失语入院，并自述存在下肢既往感觉异常。神经系统检查发现全身肌肉无力、肌阵挛反射消失及感觉减退。血清肌酸激酶（CK）水平升高，肌电图显示三角肌出现自发电纤颤电位，三角肌和胫前肌出现正锐波。运动和感觉神经传导速度轻度降低。神经活检结果符合慢性轴索性神经病，表现为有髓轴突显著丢失以及无髓轴突的失神经特征。在肌肉方面，发现了神经源性和肌源性特征的组合。前者源于轴索性神经病。后者主要表现为局灶性肌原纤维紊乱和肌纤维中自噬空泡的积累。所呈现的神经肌肉症状和体征、CK值升高、肌电图和神经传导速度检查结果以及神经和肌肉活检观察结果，均与秋水仙碱诱导的肌病和神经病的诊断相符。此外，停用秋水仙碱治疗后，感觉异常消失、CK值恢复正常，以及三角肌和胫前肌肌电图上的纤颤电位和正锐波消失，均支持该诊断。
