Introduction:
The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically,
Neisseriae meningitidis
represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to
Proteus mirabilis
infection, with postmortem evidence of WFS.
Patient concerns:
After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a
P mirabilis
infection.
Diagnosis:
Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed.
Interventions:
The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma.
Outcomes:
After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy.
Conclusion:
To our knowledge, this is the first case of MOF with WFS due to
P mirabilis
infection. This case report suggests that
P mirabilis
should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.
Takotsubo cardiomyopathy, also known as "broken heart syndrome," is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo cardiomyopathy. Ventricular rupture with Takotsubo cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options.
Deaths after ingestion of hydrogen peroxide (HP) are very rare, but poisoning due to consumption of HP is not uncommon. Most HP exposure involves common household-strength (3 %) HP and is usually benign. Even if it is not generally considered to be a poison, it can cause accidental death. HP results in morbidity through two main mechanisms: direct cytotoxic injury to tissues and formation of oxygen gas. We describe a rare case of a 2-year-old female who died after accidentally ingesting two sips of 35 % HP. For the first time, we provide histopathological images of the damage caused by HP in organic tissues.
Cyanide is a poison widely used in cases of suicide or homicide. Although various methods to identify and quantify this substance are reported in the literature, they are mainly validated on biological fluids (e.g., blood and urine). In the present study, the Anion-Exchange Liquid Chromatography with Pulsed Amperometric Detection (IC-PAD) method was validated on blood and, for the first time, on gastric content, and organs (brain, lung, and liver).
The pharmacological treatment of neoplasia is based on the use of chemotherapeutic substances. Chemotherapeutic agents can cause acute and chronic toxicity even at therapeutic doses. For this reason their overdose puts a patient's life at severe risk. This work presents an unusual fatal case of overdose subsequent to an accidental massive administration of Vinblastine (90 mg instead of 9 mg), slow bolus (five minutes), to a 33-yearold woman who suffered from Hodgkin's Lymphoma. The administration of the massive dose was due to a transcription error of the therapeutic treatment plan and miscommunication between the health professionals which caused the use of the wrong dose. The forensic investigation showed the systemic macroscopic and histological changes due to the toxic effect of Vinblastine on the body, by offering a realistic example of the microscopic tissue changes caused by the antineoplastic agent to different organs. Such evidence shows the importance of being very accurate when writing the therapeutic treatment plans and of counting on adequately-trained health care staff.
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