Colchicine is a widely utilised drug for the management of conditions such as gout, pericarditis and familial Mediterranean fever. It has a narrow therapeutic index, with a significant risk of toxicity in overdose leading to life-threatening consequences. We present a case of severe colchicine toxicity following ingestion of 20 mg (0.26 mg/kg), resulting in multi-organ failure requiring intensive care management. Rapid deterioration with hyperthermia, electrolyte derangement, rhabdomyolysis, coagulopathy and significant bone marrow suppression necessitated IV antibiotics, platelet transfusion and granulocyte colony-stimulating factor (GCSF) and subsequent admission to critical care for vasopressors and ventilatory support. The patient eventually improved with resolution of haematological and renal parameters, was reviewed by the mental health team and discharged with full functional recovery. This case underscores the importance of early recognition, aggressive supportive care, and multidisciplinary management of patients presenting with colchicine overdose, in order to achieve a favourable outcome. The unpredictable relationship between colchicine dose and clinical outcome highlights the need for close monitoring even following relatively low-dose ingestion. Increased clinician awareness of colchicine toxicity and its delayed manifestations is essential for timely intervention in such critical cases.

Large language models (LLMs) are increasingly being used by patients to seek explanations for persistent or unexplained symptoms. However, their impact on real-world diagnostic pathways and patient behavior remains poorly understood. We report the case of a 34-year-old male of Egyptian origin with recurrent episodes of fever, severe migratory abdominal pain, arthralgia, myalgia, and intermittent erythematous skin lesions since early childhood. Despite almost 3 decades of extensive investigations, no unifying diagnosis had been established. During an iterative dialogue with the LLM DeepSeek in June 2025, the differential diagnosis was progressively refined toward familial Mediterranean fever (FMF). Although the model repeatedly recommended specialist assessment, it also provided specific information regarding genetic testing and colchicine treatment. The patient subsequently arranged genetic testing independently and obtained colchicine in Egypt, initiating treatment without prior specialist assessment at 0.5 mg twice daily. His inflammatory attacks ceased completely. However, liver enzymes increased, prompting temporary treatment discontinuation and dose reduction. FMF was thereafter confirmed by specialist assessment based on the characteristic clinical phenotype, family history, genotype, and response to colchicine. This case illustrates how patient-facing LLMs may facilitate recognition of rare autoinflammatory diseases. However, confident diagnostic language combined with actionable treatment advice may also encourage unsupervised testing and self-medication, underscoring the need for clear safety boundaries and specialist confirmation.

Cardiovascular disease represents the foremost cause of mortality globally. Annually, there are approximately 720,000 new cases of myocardial infarction and 335,000 recurrent events. Coronary artery bypass grafting (CABG) continues to be a primary intervention for multivessel coronary artery disease, using venous or arterial conduits to circumvent obstructed coronary vessels. In the United States, approximately 200,000 CABG procedures are conducted each year. Compared with percutaneous coronary intervention, CABG is favored in patients with advanced atherosclerosis, diabetes, and complex coronary anatomy. Despite advancements in surgical techniques and perioperative care, CABG continues to be associated with significant complications, including infection, stroke, renal failure, pneumonia, pulmonary embolism, pleural effusion, arrhythmias, prolonged ventilatory support, myocardial infarction, post-pericardiotomy syndrome, and delirium. The occurrence of these complications is contingent on pre-existing risk factors as well as intraoperative and postoperative variables. One significant postoperative complication is atrial fibrillation, which affects 16% to 50% of patients and typically manifests 2 to 4 days following surgery. Colchicine, an anti-inflammatory agent traditionally used in the treatment of gout, familial Mediterranean fever, and pericarditis, has emerged as a potential therapeutic option for mitigating inflammation-associated complications, such as postoperative atrial fibrillation (POAF). This review investigates the role of colchicine in the prevention of POAF following CABG, analyzing proposed mechanisms, relevant clinical trials, and potential clinical implications.

Familial Mediterranean fever (FMF), an autoinflammatory disease caused by MEFV mutations, frequently coexists with immune-mediated conditions such as spondyloarthritis (SpA). However, the contribution of innate lymphoid cells (ILCs) to FMF-associated SpA remains poorly defined. Our objective was to characterize the phenotype and functional activity of ILCs in pediatric patients with FMF, SpA, and overlap FMF/SpA. Peripheral blood mononuclear cells (PBMCs) and synovial fluid mononuclear cells (SFMCs) from FMF (n = 15), SpA (n = 11), FMF/SpA (n = 13), and age-matched healthy controls (n = 14) were analyzed by flow cytometry to quantify ILC subsets. Plasma and synovial cytokines were measured by ELISA, and expression of ILC-associated cytokines in PBMCs and sorted ILCs was assessed by quantitative PCR. Total ILC frequencies and subset distributions in PBMCs and SFMCs were comparable across groups (p > 0.05). However, FMF/SpA patients demonstrated increased IL4 and IL5 expression in sorted ILCs (p < 0.05), consistent with a type 2-skewed ILC activation profile. PBMC thymic stromal lymphopoietin (TSLP) expression was elevated in SpA (p < 0.01). Plasma IL-6, IL-8 and IP-10 concentrations were higher in the full cohort of FMF/SpA patients; however, these differences were sensitive to outlier exclusion and indicate substantial inter-individual heterogeneity. Synovial fluid from SpA patients showed higher IP-10 and IL-17 levels (p < 0.05). Pediatric FMF/SpA is characterized by altered ILC functional polarization rather than numerical expansion, with a prominent type 2 ILC signature. In contrast, SpA displays synovial IP-10 and IL-17 enrichment and increased PBMC TSLP expression. These findings suggest distinct innate immune activation axes in overlap versus isolated SpA and support further investigation of ILC-mediated pathways in FMF-associated spondyloarthritis in larger cohorts.