Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users

Abstract

Background/Aim. Drug abuse remains a significant social problem in many countries. The aim of the study was to estimate association between pulmonary histopathological changes and results of toxicological analyses in forensic autopsies of illicit drug users. Methods. This investigation was performed in the Institute of Forensic Medicine, Belgrade, and in the Clinical Center, Department of Forensic Medicine, Kragujevac, from 2000 to 2004, and included 63 medicolegal autopsies of heroin or other drug consumers who suddenly died. Autopsies, postmortem toxicological examination of drugs and serological analyses of anti- HIV/HBV/HCV antibodies were performed. Results. The deceased persons were mostly male, 46/63 (73.01%), ranged in age from 19 to 49 years (mean 31 years) and all were whites. Postmortem toxicological examination was performed on all of the deceased persons and drugs in the fatal range were identified in only eight of them (12.7%), in the toxic range in ten (15.87%), and in minimal concentrations in 35 (55.56%) of the deceased persons. Drugs identified in the fatal, toxic or minimal range included heroin-morphine (38/53), cocaine (4/53), tramadol (3/53), and lorazepam (1/53). In the 7 remaining subjects, ethanol in combination with heroin was found in 4 cases, and diazepam in combination with heroin in 3 cases. Dominant pathomorphological changes were findings in the lung tissue. Most common histological changes observed in drug users were pulmonary edema - 55/63 (87.3%), acute alveolar hemorrhages - 49/63 (77.78%), hemosiderin-laden macrophages (siderophages) - 52/63 (82,54%), and emphysematous changes - 51/63 (80,95%). Conclusion. Pulmonary edema is the frequent non-specific autopsy finding which is associated with virtually all routes of drug administration. The histopatological study is necessary to determinate a cause of death when a deceased person has the history of dependence or abouse of psychoactive drugs with negative toxicological results.Uvod/Cilj. Zloupotreba droga i dalje predstavlja znacajan drustveni problem u mnogim zemljama. Cilj istrazivanja bio je da se ispita udruzenost, patohistoloskih promena i rezultata toksikoloskih analiza kod sudskomedicinski obdukovanih narkomana. Metode. Istrazivanje je obavljeno u Institutu za sudsku medicinu u Beogradu i Sluzbi za sudsku medicinu Klinickog centra Kragujevac u periodu od 2000. do 2004. godine, i obuhvatilo je 63 sudskomedicinske obdukcije iznenadno umrlih heroinskih zavisnika i korisnika drugih droga. Uradjene su obdukcije, postmortalna toksikoloska ispitivanja na prisustvo droga i seroloske analize na prisustvo antiHIV/HBV/HCV antitela. Rezultati. Vecina umrlih osoba bili su muskarci 46/63 (73,01%), najmladji je imao 19, a najstariji 49 godina (prosecna starost 31 godina) i svi su bili bele rase. Postmortalno toksikolosko istrazivanje obavljeno je kod svih umrlih osoba i droge u letalnoj koncentraciji pronadjene su samo kod njih 8 (12,7%) osoba, u toksicnoj koncentraciji kod 10 (15,87%) i u minimalnoj koncentraciji kod njih 35 (55,56 %). Droge koje su identifikovane u letalnoj, toksicnoj ili minimalnoj koncentraciji bile su: heroin-morfin (38/53), kokain (4/53), tramadol (3/53) i lorazepam (1/53). Od preostalih sedam leseva, kod cetiri pronadjen je etanol u kombinaciji sa heroinom, a kod tri diazepam u kombinaciji sa heroinom. Najizrazenije patomorfoloske promene pronadjene su u plucnom parenhimu. Najcesce uocene histoloske promene kod korisnika droga bili su: plucni edem, 55/63 (87,3%), akutne alveolarne hemoragije 49/63 (77,78%), hemosiderofagi 52/63 (82,54%) i emfizematozne promene 51/63 (80,95%). Zakljucak. Plucni edem je najcesci nespecificni obdukcijski nalaz povezan sa svim nacinima unosenja droga. Neophodno je uraditi patohistolosko ispitivanje preminulih osoba sa negativnim toksikoloskim nalazom, ali pozitivnom anamnezom o zavisnosti ili predoziranju psihoaktivnih lekova.