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Crossbows are weapons that shoot arrow-like projectiles using an elastic launching mechanism activated by a gun-like trigger. Accidental deaths due to crossbow injuries have been rarely reported in forensic practice. In this case report, a 40-year-old man was found dead in the woods with a wound to the upper torso. The wound was observed to have a corresponding slit-like defect in each layer of his clothing. A blood-stained crossbow with the safety features off was found at the scene, along with a nearby partially bent arrow. At autopsy, a hemorrhagic sharp-edged penetrating track was found in the left upper chest, which injured the subclavian vessels. The mechanism of death was determined to be severe bleeding due to the penetrating wound. Toxicological analyses of blood showed methamphetamines and metabolites of cocaine. According to the available evidence, the manner of death was determined to be an accident. In crossbow-related deaths, particularly when the arrow is removed from the wound, determining the weapon used proves challenging because of the similarity of the resulting wounds to the wounds of other weapons. This case report highlights the importance of integrating critical crime scene investigation with autopsy findings to reach a correct manner of death.

Ornithine Transcarbamylase (OTC) is an enzyme of the urea cycle, which converts ammonia into urea in the liver cells. OTC plays a crucial role in the breakdown and removal of nitrogen in the body. OTC deficiency is a rare X-linked recessive disorder that classically presents in early life with signs of hyperammonemia and progressive central nervous system involvement resulting in seizures, coma, and death. Sentinel presentation in adulthood is quite rare. A 29-year-old man developed altered mental status after receiving an epidural steroid injection 3 days earlier for back pain. He presented to the emergency department severely agitated, and his workup revealed an elevated ammonia level of 125 µmol/L. He refused admission and was discharged against medical advice. The following day, his mentation deteriorated, he developed status epilepticus, and was transported to another emergency department. He was admitted with worsening hyperammonemia (levels rising to over 700 µmol/L). His clinical condition progressive deteriorated, and he developed encephalopathy and diffuse cerebral edema. Liver function testing indicated progressive liver damage, and amino acids were detected in his blood and urine. Clinical and laboratory findings suggested undiagnosed OTC enzyme deficiency. He died 2 days after admission.An autopsy showed an 1890 g liver with diffuse yellow discoloration and softening.Histology and electron microscopy revealed findings suggestive of urea cycle disorder, such as microvesicular steatosis, apoptosis, and scattered mitosis, clusters of clear hepatocytes at the PAS stain, and mitochondria abnormalities. Genetic analysis revealed a hemizygous pathogenic variant of the OTC gene (c.622G>A). OTC deficiency should be suspected in subjects with hyperammonemic encephalopathy. If a genetic mutation is identified in the deceased, surviving family members should be screened to prevent potential life-threatening complications.

Hanging is a common method of suicide and multiple autopsy findings can be observed at the postmortem examination. Simon's sign is a haemorrhage into the anterior aspect of the intervertebral discs of the lumbar region that can be observed in hangings and other traumatic causes of death. This finding is considered evidence of vitality. Several mechanisms have been proposed regarding bleeding development. In this paper, we present a case of hanging in which Simon's sign was observed at the autopsy. A review of the literature regarding Simon's bleeding has been performed, and a discussion of the potential mechanism is reported. Although Simon's sign may be observed in hangings, a careful evaluation of all the available data, including investigation, autopsy findings, and toxicology, is mandatory to avoid misinterpretation of death's cause and manner.