In Tunisia, hydatid cyst is an endemic parasitic disease. The cyst may remain asymptomatic, discovered accidentally, or in case of a complication, the most serious of which is sudden death. We propose, in this article, to analyze the degree of involvement of the cyst in the mechanism of death, through the review of 25 cases. A total of 7932 autopsy cases were performed during the study period. Twenty-five cases of hydatid cyst discovered at autopsy were collected and death was attributed to hydatid cyst in 13 cases. The seat of the cyst was variable and death was due to anaphylaxis in 10 cases, to hydatious embolism in 2 cases and to cardiac arrhythmia, resulting from a cardiac localization of a large hydatid cyst, in 1 case.Although rare, echinococcosis can be a life-threatening disease. Its involvement in the death mechanism remains difficult in many cases.
Para phenyl diamine (PPD) is an aromatic amine derivative of Aniline that is widely used as a cosmetic product, particularly in hair dye preparations. PPD acute poisoning leads to respiratory distress, rhabdomyolysis, muscle necrosis and renal failure. Cardiac complications are rarely reported in the literature. We will present a case of PPD poisoning presenting as myocarditis, associated to rhabdomyolysis with a fatal outcome. A 22-year-old man was hospitalized for ingestion of a hair dye. At admission it had a severe edema of the face and neck. Laboratory exams showed renal failure, increased serum lactate deshydrogenase, creatine phosphokinase and troponine T. Toxicological screening showed the presence of Paraphenyl Diamine in blood and stomach. The patient died in the tenth day due to a cardiogenic shock. A forensic autopsy was performed. The pericardium was spotted by multiple hemorrhagic petechiae. The myocardium and the epicardium had multiple hemorrhagic areas. Histological examinations revealed the presence of acute inflammation of the myocardium and epicardium associated with severe ulceration of the endocardium. Inflammatory infiltrate consisted mainly of neutrophils with frequent micro abscesses in the myocardium and epicardium. Death was attributed to Paraphenyl Diamine poisoning complicated with rhabdomyolysis and acute myocarditis.
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