Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death

Abstract

Lysoform® in the formulation of professional detergent is widely used in several fields, whereas its suicidal ingestion is an unusual occurrence. Therefore, the biological signs of this fatal poisoning remain unclear and elusive, similarly to the histological lesions induced by its main constituent, which is benzalkonium chloride (BZK). Furthermore, since all the deaths that has been reported in the literature occurred immediately, microscopic pictures of BZK lethal toxicity in subjects with prolonged survival have never been reported to date. Specifically, this brief communication reports the unique case of a woman who ingested professional Lysoform® to commit suicide, for which she died two weeks later. The autopsy examination showed either local or systemic signs of caustic ingestion; moreover, the histological analysis showed clear cellular damage of lungs, heart, and kidneys. In our case, toxicological investigations were not authorized as they were no longer considered significant. In this framework, the histological examination has therefore assumed a fundamental role in investigating and demonstrating the lethal effects caused by the systemic dissemination of BZK, which would otherwise no longer be investigable. Therefore, in cases of substance intoxication with prolonged survival where forensic toxicological investigations may be no longer possible or feasible, the histological examination may be the only resource to successfully observe and demonstrate its lethal effects.

A Forensic Case of Suicide Ingestion of Paraquat Herbicide

“…This is correct from a procedural point of view, but it should never be forgotten that toxic substances are such as they are able to exert their damaging action directly or indirectly on biological tissues, leaving signs that only microscopic examination can bring out and correctly characterize in the pathophysiological reconstruction of the death event. From this derives the need to always associate histopathological with toxicological analysis, because, in addition to providing direct confirmation of the harmful effects produced by the substance, it can also bring to light specific peculiarities not yet known or rarely reported in literature, such as cardiac hemorrhage associated with the ingestion of caustic substances 39,40 . This becomes even more crucial in cases of more or less prolonged survival periods after exposure to substances of toxicological interest, which, in the forensic field, are still poorly described, because, most of the times, the lethal event is immediate.…”

“…From this derives the need to always associate histopathological with toxicological analysis, because, in addition to providing direct confirmation of the harmful effects produced by the substance, it can also bring to light specific peculiarities not yet known or rarely reported in literature, such as cardiac hemorrhage associated with the ingestion of caustic substances. 39,40 This becomes even more crucial in cases of more or less prolonged survival periods after exposure to substances of toxicological interest, which, in the forensic field, are still poorly described, because, most of the times, the lethal event is immediate. In this context, PQ deaths are no exception, and the histological findings that emerge may be of clinical relevance in optimizing the treatment and management of these patients.…”

Benzalkonium Chloride Poisoning in Pediatric Patients: Report of Case with a Severe Clinical Course and Literature Review

“…In a review of cases of both adults [ 16 , 43 , 44 ] and children [ 45 , 46 , 47 , 48 , 49 ] who survived the ingestion of BAC solutions, strictures were described in only a few neonatal cases [ 48 ]. Therefore, the positive outcome in our patient and the management or nature of the substance involved are likely not directly nor causally related.…”

“…The rapid development of acute respiratory distress in this patient may be related to laryngeal edema and BAC-induced bronchoconstriction through the release of mediators from mast cells and the stimulation of cholinergic receptors [ 16 ]. The mechanisms of lung toxicity have been extensively studied via animal models [ 18 ], cell culture investigations [ 12 ], and forensic reports [ 16 ], resulting in the characterization of BAC-induced lung injury. Based on these data and previously reported cases [ 43 , 46 , 47 , 48 , 49 ], we concluded that our patient developed chemical pneumonitis because he aspirated the BAC solution.…”

“…The manifestations of BAC largely overlap with those of alkali compounds, with corrosive tissue damage being the predominant characteristic [ 16 , 17 ]. However, BAC toxicological profiles have revealed specific effects, including apoptosis-induced lung injury [ 12 , 16 ], bronchoconstriction [ 18 ], and hypersensitivity reactions [ 19 , 20 , 21 , 22 ].…”