title: Unexpected double lethal oleander poisoning.
abstract: Nerium oleander is a very popular urban ornamental plant in Europe, but it is also extremely dangerous because it contains several types of glycosides, accidental ingestion of which can cause cardiac arrhythmias and even deaths. The rarity of such cases makes it difficult to think of oleander poisoning without evidences that suggest this possibility as the cause of the unexpected death. This report concerns the discovery of the bodies of 2 young people, a man and a woman, in a forest in conditions of extreme malnutrition. Medicolegal investigations showed neither pathologic nor traumatic causes of death, but the presence of vegetal remains in the stomach was noticed. A common toxicological analysis resulted negative, but the implementation of more detailed investigations showed the presence of digoxin in the blood of both cadavers, excluding the possibility of a pharmaceutical provenience of digoxin, this laboratory result was interpreted as evidence of ingestion of oleander, which contains oleandrine, the cross reaction of which with digoxin is widely described in the literature. Identification of the 2 subjects, which occurred after 4 years, strengthened the hypothesis of accidental poisoning by oleander because it was ascertained that the 2 young people were vegans--extreme vegetarians who reject the ingestion of foods of animal origin and live by eating only what they find in nature.
authors.affiliation: Department of Legal Medicine, University of Pisa, Italy, USA. l.papi@med.unipi.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Papi
authors.forename: Alessandro Bassi
authors.initials: AB
authors.lastname: Luciani
authors.forename: David
authors.initials: D
authors.lastname: Forni
authors.forename: Mario
authors.initials: M
authors.lastname: Giusiani
mesh_terms: D000328:Adult; D002298:Cardenolides / Q000032:analysis / Q000506:poisoning; D002301:Cardiac Glycosides / Q000032:analysis / Q000506:poisoning; D004077:Digoxin / Q000097:blood; D005260:Female; D053593:Forensic Toxicology; D005766:Gastrointestinal Contents; D006801:Humans; D008297:Male; D030007:Nerium / Q000737:chemistry / Q000506:poisoning*
chemical_list: D002298:Cardenolides; D002301:Cardiac Glycosides; D004077:Digoxin; C021065:oleandrin