A 44-year-old Caucasian female was found dead in bed. Qualitative screening detected ethanol, phenobarbital, and methotrimeprazine. However, none were sufficient to attribute as the cause of death. Additionally, high concentrations of topiramate, an antiepilieptic agent, were found. Analysis of available biological fluids and tissues was carried out with the following results: blood (central) 170 mg/L, liver 140 mg/kg, stomach contents greater than 300 mg, and vitreous fluid 65 mg/L. The cause of death was ascribed to topiramate overdose.

In patients with eating disorders who may already have exhibited these symptoms pancreatitis may not be considered. Elevated serum amylase values may occur in subjects with bulimia nervosa without pancreatitis. If the serum amylase value is elevated, pancreatitis can be confirmed by measuring the levels of serum lipase, trypsinogen, pancreatic isoenzyme of amylase, or by abdominal computerized tomography (CT).

Two cases of melanosis ilei were studied, in which grossly visible blackish pigmentation of the ileal mucosa was incidentally discovered at autopsy. Light microscopy showed that the pigment granules lay within macrophages in atrophic Peyer's patches. Ultrastructural studies showed that the pigment granules were heterolysosomes containing crystalline material, particles, granules and, occasionally, lipid droplets. The morphological similarity between these pigment granules and granules in pulmonary macrophages was established through ultrastructural studies of pulmonary lymph nodes obtained during routine autopsies. These data, plus results of past electron-probe X-ray analytic studies by us and others, leads us to conclude that the pigment granules in melanosis ilei contain exogenous material derived from inspired and ingested materials.

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Clinical Pharmacology & Therapeutics (1996) 59, 158–158; doi: