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Methiopropamine (1-(thiophen-2-yl)-2-methylaminopropane) is a synthetic methamphetamine analogue and is classified as a novel psychoactive substance. The use of novel psychoactive substance has been increasing substantially for recreational purpose in recent years. Methiopropamine was first detected in 2011 in Finland and was later detected in the United Kingdom. It can be purchased on the Internet and is currently poorly regulated. Reported adverse effects of methiopropamine use are mostly anecdotal user reports on Internet forums, and there are limited data on its pharmacodynamics and toxicity in the literature. Death as a direct result from methiopropamine toxicity has not been reported in Australia. We report here the first case of death caused by recreational use of methiopropamine in Australia. This same incident highlights the first ever death from isolated methiopropamine use. Being an analogue of methamphetamine, we hypothesize that the mechanism of death caused by methiopropamine would not be dissimilar to methamphetamine.

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The diagnosis of anaphylaxis in the postmortem setting remains a significant challenge for pathologists. The performance of postmortem serum tryptase is commonly used in the investigation of suspected anaphylactic deaths; however, not only have tryptase levels been found to be elevated in nonanaphylactic deaths, the effect of the postmortem interval on serum tryptase is not fully understood. There are no studies on serial measurement of tryptase in the postmortem setting. We report a death from anaphylaxis in which 2 separate serum tryptase measurements taken 24 hours apart from the same femoral vein showed a substantial decline from 130.0 ug/L at day 2 after death to 84.4 ug/L at day 3. We hypothesize that the decline may be due to degradation of the degranulated mast cell tryptase in anaphylactic deaths. Serial measurement of postmortem serum tryptase may assist in understanding the complex field of serum tryptase interpretation in the postmortem setting. We suggest that an early blood sample to be obtained as soon as possible after death in cases where anaphylaxis is suspected, because there appears to be a significant decline in tryptase levels with increasing postmortem interval.

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