Case of Sudden Death due to Septic Pulmonary Embolism

Abstract

INTRODUCTION: Sudden deaths in hospital following a short duration of seemingly improving illness arouse suspicion of medical maltreatment. It is mandatory to have a medico-legal investigation in to such deaths. Facts, explanations, and opinions made by the forensic pathologists at the end of an autopsy examination are of crucial importance to eliminate or confirm such doubts. We report how a thorough autopsy examination including ancillary testing can lead to effective administration of justice in such cases. CASE HISTORY: A 42 year woman with diabetes mellitus was admitted to hospital with fever and right knee joint swelling and tenderness of one week’s duration. There was cellulitis over the right knee joint and underlying septic arthritis. Surgical drainage of the joint was done and intra venous antibiotics were given and the condition seemed to be improving. On the 4th day of admission, she developed sudden onset of shortness of breath and central chest pain resulting in death 12 hours later. At autopsy she was pale and icteric. There was evidence of septic arthritis with surrounding necrotizing fasciitis and deep venous thrombosis of the right calf. There was consolidation of the right lung with patchy focal pale yellow areas with surrounding erythema, and evidence of multi-organ sepsis. Microscopy confirmed multi organ involvement and revealed pneumonia of the right lung with early abscess formation and multiple bilateral peripheral septic thrombo emboli. There was septic thrombosis of the calf veins with associated thrombo phlebitis. CONCLUSION: Facts revealed at autopsy explained the sudden death and the possibility of such death was scientifically clarified. The cause of death was concluded as septic pulmonary thrombo embolism due to deep venous septic thrombosis and thrombophlebitis due to septic arthritis and necrotizing fasciitis.