Lauren K Santoro, Devan C Glensor, Daniel V Sullivan, J Jun Guan
{"title":"Sudden Unexpected Death Due to Undiagnosed Pilocytic Astrocytoma.","authors":"Lauren K Santoro, Devan C Glensor, Daniel V Sullivan, J Jun Guan","doi":"10.1097/PAF.0000000000001041","DOIUrl":"10.1097/PAF.0000000000001041","url":null,"abstract":"<p><strong>Abstract: </strong>Pilocytic astrocytomas are slow-growing neuroepithelial tumors most commonly found in children, with favorable prognoses. Prognosis is less favorable in the rare adult case in which survival rates decrease with age. Because of the rarity of these tumors in adults, undiagnosed pilocytic astrocytomas causing sudden death are hardly ever encountered in the forensic autopsy setting. The San Francisco Office of the Chief Medical Examiner was presented with a 27-year-old female patient with unknown medical history and recent complaints of nausea and vomiting. Postmortem computed tomography revealed a well-demarcated heterogeneous right cerebellar cystic mass. The autopsy showed an edematous brain with hydrocephalus and fourth ventricular compression, due to a heterogeneous mass found in the right cerebellum. Histopathological examination of the mass revealed findings consistent with the microscopic diagnosis of pilocytic astrocytoma. This case highlights one example of an adult patient with untreated pilocytic astrocytoma in which obstructive hydrocephalus ultimately resulted in death, and discusses the advantages of utilizing post-mortem computed tomography in addition to autopsy.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yi Zhu, Julian A Villalba, Jennifer Kasten, Marlene DeLeon Carnes, Julu Bhatnagar, Ross Zumwalt
{"title":"Sudden Death With Lyme Disease Myocarditis: A Case Report.","authors":"Yi Zhu, Julian A Villalba, Jennifer Kasten, Marlene DeLeon Carnes, Julu Bhatnagar, Ross Zumwalt","doi":"10.1097/PAF.0000000000001045","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001045","url":null,"abstract":"<p><strong>Abstract: </strong>Death from myocarditis due to Lyme disease is uncommon but may be under-recognized. Myocarditis can lead to sudden and/or unexpected death due to fatal cardiac arrhythmias, which may be misattributed to more common causes, such as coronary artery disease. We report an unexpected death in a 69-year-old man from a Lyme-endemic area who had multiple cardiovascular risk factors. His death was initially attributed to coronary artery disease by the local coroner's office but was later confirmed to be due to Lyme disease, based on positive serological testing, characteristic cardiac histopathology findings, and the detection of Borrelia burgdorferi spirochetes, antigens, and DNA in the heart using various methods. Forensic pathologists should maintain a high suspicion of Lyme carditis, particularly in cases of sudden/unexpected death in Lyme-endemic areas. A history of rash or recent insect bites should prompt serologic testing for Lyme disease.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lindsey M Martens, Allison B Anderson, Selly Strauch, Susan Roe
{"title":"A Self-immolation Dilemma.","authors":"Lindsey M Martens, Allison B Anderson, Selly Strauch, Susan Roe","doi":"10.1097/PAF.0000000000001049","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001049","url":null,"abstract":"<p><strong>Abstract: </strong>Setting oneself on fire, termed self-immolation, has high mortality and morbidity.A 60-year-old female patient with a history of depression and anxiety was found by drone search deceased with thermal injuries in a cornfield. Her abandoned vehicle was found with a dead battery and out of fuel 1/4 mile away. A lighter was lying 8 feet from the decedent, and a string of rosary beads, clothing, cigarettes, pliers, and a glass bottle with a cross on it were found nearby.Autopsy findings were notable for charring of the face, torso, and portions of the extremities, soot deposition in the peripheral airways, erythema of the epiglottis, bilateral lateral tongue hemorrhages, and pulmonary congestion and edema.The toxicology report revealed a blood carbon monoxide level of 23.8%. A blood volatile screen was negative. Blood drug screen was positive for a metabolite of marijuana and loperamide.The patient was determined to be alone at the time of the fire and death. No fuel or ignitable fluid was identified. The origin of the fire and the manner of death were listed as undetermined. The cause of death was determined to be thermal injuries and smoke inhalation. Whether this case represents a deliberate act or a possible accident remains in question.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Semaglutide and GLP-1 Agonists: Forensic and Medicolegal Implications.","authors":"Michael Fagiola","doi":"10.1097/PAF.0000000000001044","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001044","url":null,"abstract":"<p><strong>Abstract: </strong>This article is intended as a brief review on the glucagon-like peptide-1 (GLP-1) agonist Semaglutide (Ozempic®, Rybelsus®, Wegovy®), an antidiabetic medication that has gained significant popularity in the United States for its role in long-term weight-loss management. While current research on GLP-1 agonists, including semaglutide, focuses primarily on their therapeutic effects in managing diabetes and obesity, information regarding their forensic and medicolegal significance is limited. Concerns related to GLP-1 agonists may arise due to their pharmacokinetics, potential drug-drug interactions, and side effects including hypoglycemia, which can be relevant in cases involving human performance, such as impaired driving, or in unexpected fatalities. Semaglutide additionally presents analytical challenges due to its large, highly charged molecular structure and potentially limited stability in whole blood, which may complicate its detection and quantification in forensic laboratories using common instrumentation. The development of robust analytical methods will be essential to account for its pharmacological effects and to address its potential role in intoxications or unexplained fatalities, especially in the context of misuse or off-label use for weight loss. A strong case can be made for the necessity of further research into the detection, quantification, and interpretation of semaglutide concentrations in forensic toxicology casework.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madison L Esposito, Katlin T Wilson, Jamie E Kallan
{"title":"Building Partnerships With Tribal Nations: A Call for Cultural Sensitivity in Forensic Examinations.","authors":"Madison L Esposito, Katlin T Wilson, Jamie E Kallan","doi":"10.1097/PAF.0000000000001046","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001046","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Announcing Video Abstracts.","authors":"D Kimberley Molina","doi":"10.1097/PAF.0000000000001047","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001047","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jack Garland, Benjamin Ondruschka, Ugo Da Broi, Cristian Palmiere, Rexson Tse
{"title":"Difference in Central and Peripheral Total Tryptase Concentration/Level in Fatal Anaphylaxis: A Case Report.","authors":"Jack Garland, Benjamin Ondruschka, Ugo Da Broi, Cristian Palmiere, Rexson Tse","doi":"10.1097/PAF.0000000000001048","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001048","url":null,"abstract":"<p><strong>Abstract: </strong>Postmortem tryptase is an adjunct test to assist in diagnosing fatal anaphylaxis. A series of recent studies have shown that postmortem total tryptase concentrations/levels varied between central and peripheral blood samples in normal population. However, it is unclear whether it also varies between central and peripheral blood samples in fatal anaphylaxis. We document a death from anaphylaxis triggered by radiocontrast. Postmortem total tryptase concentrations/levels in arterial and venous central blood collected from the aorta and inferior vena cava were >200 μL/L, whereas arterial and venous peripheral blood collected from femoral artery and veins were ~110 μg/L. This case report provides evidence that postmortem total tryptase concentrations/levels also vary in central and peripheral blood samples in anaphylactic deaths.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Incidental Autopsy Finding of Intraosseous Dermoid Cyst With Craniosynostosis: A Case Report.","authors":"Sarah Waszyn, Michael Belenky","doi":"10.1097/PAF.0000000000001037","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001037","url":null,"abstract":"<p><strong>Abstract: </strong>Dermoid cysts are benign developmental anomalies that are typically cutaneous and occur along lines of embryonic closure. Rarely, intraosseous dermoid cysts can occur in the pediatric population. This report presents an incidental finding of an intraosseous dermoid cyst found during autopsy in the frontal bone of a 3-year-old female patient who died by drowning. The cyst measured 1.2 × 0.7 × 0.6 cm and was located along the sagittal suture. Histopathologic examination of the cyst revealed keratinized stratified squamous epithelium alongside sebaceous glands and hair follicles, confirming the diagnosis of dermoid cyst. Premature closure of all cranial sutures, or craniosynostosis, was also noted. This unique combination of findings may indicate an etiological connection, which may warrant further research. Furthermore, this report provides rare photographs while most intraosseous dermoid cysts are only captured via radiography. From a forensic pathology perspective, incidental findings like these can provide critical insights into congenital anomalies that may impact the family, future research, or medicolegal conclusions, highlighting the broader relevance of thorough autopsies. Moreover, incidental findings such as this case contribute to the growing need for forensic guidelines on how to manage and document unexpected discoveries during investigations.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Skeletonization of Human Remains by Amazonian Ichthyofauna in Less Than 24 Hours.","authors":"Gisleine Medrado, Daniela Nóbrega, Priscila Kitagawa, Sanmya Leite, Ademir Franco","doi":"10.1097/PAF.0000000000001042","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001042","url":null,"abstract":"<p><strong>Abstract: </strong>Deaths in water present unique challenges for forensic experts, particularly the impact of ichthyofauna on human remains. Species of necrophagous-carnivorous fish can rapidly consume bodies in shoals, obliterating crucial evidence. As a result, determining the cause of death and identifying the deceased become more difficult. This study reports a case of a human body skeletonized in less than 24 hours by ichthyofauna following an accidental fall into the Amazon River. Only cartilaginous structures of the nose and ears, the male genitalia, and the feet and hands of the individual remained. The latter exhibited punch-out-shaped wounds. While the cause of death remained inconclusive, identification was achieved through fingerprint analysis. Forensic experts must recognize the role of necrophagous ichthyofauna to prevent misinterpretation of wounds, facilitate accurate cause-of-death investigations, and expedite human identification.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew Johnson, Kathryn Manocchia, Marisa Jacob-Leonce
{"title":"Getting Crunchy With COVID-19: A Unique Case of Catastrophic Multiorgan Calciphylaxis.","authors":"Andrew Johnson, Kathryn Manocchia, Marisa Jacob-Leonce","doi":"10.1097/PAF.0000000000001035","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001035","url":null,"abstract":"<p><strong>Abstract: </strong>Calciphylaxis, or calcific uremic arteriolopathy, is a rare condition with a poorly understood pathophysiology. It is often associated with diseases that cause abnormalities in calcium metabolism, such as end-stage renal disease (ESRD) and hyperparathyroidism. While it most often affects the skin, involvement of extracutaneous organs, called systemic calciphylaxis, has been reported.Interestingly, other risk factors have now been identified with the development of calciphylaxis including recent infections, corticosteroid or warfarin use as well as diabetes mellitus, autoimmune diseases, and protein C or S deficiency.We present a 48-year-old female patient with a history of human immunodeficiency virus infection, and recent hospitalizations for acute pancreatitis and COVID-19 who presents with nonspecific abdominal pain, weakness, and mild erythematous skin lesions. Subsequently, the patient developed acute vision loss, severe hypertension, and acute kidney injury with significantly worsening skin lesions. Ultimately, the patient deteriorated rapidly and succumbed. At autopsy, cutaneous calciphylaxis was confirmed, affecting over 50% of body surface area as well as widespread organ involvement by visceral calciphylaxis, most strikingly in the heart and lungs. This case highlights the importance of considering COVID-19 and other nonuremic risk factors as being a trigger for developing catastrophic systemic calciphylaxis.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}