Teaching NeuroImages: Colchicine-induced vacuolar myopathy

Abstract

An 86-year-old man presented with 1 year of insidiously progressive weakness that started around 2 weeks after colchicine initiation for gout. Examination noted proximal more than distal weakness with diffuse hyporeflexia. Creatine kinase was 3,172 U/mL and electrodiagnostic study was consistent with a myopathic process. Muscle biopsy (figure) showed necrotizing myopathy with vacuoles, as well as mild chronic denervation/reinnervation. Weakness improved after cessation of colchicine.