A rare case of fatal materno-fetal methanol poisoning. Volatile congeners analysis as forensic evidence

Abstract

Background. Methanol intoxication may be the result of either accidental or intentional ingestion, in case of substantial exposures coma and death may occur. Methanol poisoning during human pregnancy was rarely described. Material and method. We present the case of a 39-years old pregnant woman hospitalized for severe methanol intoxication. We reviewed the entire hospital medical documentation and performed blood and gastric content analysis for alcohol congeners using validated headspace-gaschromatography method (samples collected at admission from mother and at autopsy from fetus); we also examined all organs of the mother and of the stillborn, including microscopic sections stained with haematoxylin-eosin. Results and discussions. The 34 weeks pregnant patient was transported to the hospital due to respiratory distress, lethargy and coma. Laboratory findings revealed metabolic acidosis with anion gap. At presentation intrauterine fetal death was diagnosed and the fetus was extracted next day. The woman died after four days in hospital. At post-mortem examination we found marked brain edema, brain stem hemorrhages, focal bleedings in the white matter of the temporal and parietal lobes, leptomeningeal hyperaemia, kidneys with tubular necrosis and hemorrhages in renal cortex. Autopsy of the fetus revealed only leptomeningeal hyperaemia, suggesting a rapid death. Blood ethanol concentration was 1.03 g/l in mother and 1.98 g/l in foetus while methanol concentration was 1.72 g/l and 1.99 g/l respectively. Relatively high amounts of amyl-alcohol (2-methyl 1-butanol) in both samples indicate consumption of fruit distillate, while toxic blood methanol concentration can be explained only by contaminated beverage consumption. Conclusions. Intrauterine fetal death may occur without important morphological lesions in case of methanol transplacentar intoxication. Methanol is rapidly transferred to the fetus and cumulates in fetal circulation, while in case of other volatile congeners the transfer through the placental barrier seems to be selective.