title: Black esophagus: acute esophageal necrosis in fatal haloperidol intoxication.
abstract: Herein, we present a case of 53-year-old psychotic woman with acute esophageal necrosis (black esophagus), who was found lying on the floor in the living room of her flat. Pillboxes of antipsychotic drugs were located in the bin. External examination of the body was unremarkable. On internal examination, we found acute esophageal necrosis. Histologically, there was complete epithelial necrosis with focal involvement of muscularis mucosae, dense infiltrate of leukocytes, and ulcerations without any viable cells. There was no evidence of underlying organic diseases or trauma. Toxicological analysis revealed a fatal blood level of antipsychotics (haloperidol, zotepine, and chlorprothixene). Death of the deceased was attributed to fatal intoxication with three various types of antipsychotics. As far we know, this is the first described association between so-called black esophagus and fatal blood level of neuroleptics.
authors.affiliation: Institute of Legal Medicine, Medical Faculty of Charles University and University Hospital Hradec Králové, Šimkova 870, Hradec Králové 500 38, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hejna
authors.affiliation: Institute of Legal Medicine, Medical Faculty of Charles University and University Hospital Hradec Králové, Šimkova 870, Hradec Králové 500 38, Czech Republic.
authors.forename: Michaela
authors.initials: M
authors.lastname: Ublová
authors.affiliation: Institute of Clinical Biochemistry and Diagnostics, Medical Faculty of Charles University and University Hospital Hradec Králové, Sokolovská 581, Hradec Králové 500 05, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Voříšek
mesh_terms: D014150:Antipsychotic Agents / Q000097:blood / Q000506:poisoning*; D002749:Chlorprothixene / Q000097:blood / Q000506:poisoning; D003988:Dibenzothiepins / Q000097:blood / Q000506:poisoning; D004947:Esophagus / Q000473:pathology*; D005260:Female; D049429:Forensic Pathology; D006220:Haloperidol / Q000097:blood / Q000506:poisoning*; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology
chemical_list: D014150:Antipsychotic Agents; D003988:Dibenzothiepins; D002749:Chlorprothixene; D006220:Haloperidol; C022172:zotepine
keywords: acute esophageal necrosis; autopsy; black esophagus; fatal intoxication; forensic science; haloperidol; neuroleptics; suicide