Postmortem diagnosis of fatal anaphylaxis during intravenous administration of therapeutic and diagnostic agents: evaluation of clinical laboratory parameters and immunohistochemistry in three cases.
This report documented three autopsy cases involving fatal shock during intravenous injection of therapeutic and diagnostic agents in a hospital setting. For postmortem diagnosis, clinical laboratory parameters for anaphylaxis, specificity of antibodies for allergens and mast cell numbers in tissue sections were examined. Elevated plasma tryptase levels were evident in the three adult males; two of the three victims displayed elevated IgE levels. However, immunoassay failed to detect antibodies specific to the relevant agent. Double immuno-staining was performed employing anti-tryptase and anti-chymase monoclonal antibodies in order to count mast cells in lung sections. Increased numbers of mast cells were observed in anaphylactic tissues, which was particularly true for chymase-positive cells, in comparison with tissues associated with acute traumatic deaths. In addition to findings at autopsy, positive data obtained by laboratory examinations and immunohistochemical analyses indicated that fatal systemic anaphylaxis occurred during intravenous injection of clinical agents.
Department of Forensic Medicine, Tokai University Faculty of Medicine, Boseidai, Isehara, Kanagawa 259-1193, Japan. osawa@is.icc.u-tokai.ac.jp
Motoki
M
Osawa
Fumiko
F
Satoh
Hidekazu
H
Horiuchi
Wei
W
Tian
Nobuko
N
Kugota
Iwao
I
Hasegawa
D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000707:Anaphylaxis / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000906:Antibodies; D016022:Case-Control Studies; D015310:Cefotiam / Q000008:administration & dosage / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D049429:Forensic Pathology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007150:Immunohistochemistry; D007275:Injections, Intravenous; D007485:Ioxaglic Acid / Q000008:administration & dosage / Q000009:adverse effects; D007819:Laryngeal Edema / Q000473:pathology; D008168:Lung / Q000378:metabolism / Q000473:pathology; D008297:Male; D008407:Mast Cells / Q000378:metabolism; D008875:Middle Aged; D012769:Shock / Q000139:chemically induced*; D053802:Tryptases / Q000097:blood / Q000276:immunology
D000700:Analgesics; D000900:Anti-Bacterial Agents; D000906:Antibodies; D003287:Contrast Media; D007073:Immunoglobulin E; D015310:Cefotiam; D053802:Tryptases; D007485:Ioxaglic Acid