title: Unexpected post-mortem diagnosis of systemic sclerosis presenting as pneumatosis intestinalis: revised diagnostic criteria and medicolegal implications.
abstract: Systemic sclerosis is a challenging diagnosis for clinicians and pathologists alike due to its protean manifestations and often insidious onset, particularly in cases without significant titres of auto-antibodies. Herein we present a case of a female in her sixties who died rapidly following a clinical diagnosis of pneumatosis intestinalis and respiratory failure of unclear etiology. Recently revised clinical diagnostic criteria were applied to the clinical history and postmortem findings to reach an unexpected diagnosis of systemic sclerosis. The diagnosis of systemic sclerosis at autopsy has important medicolegal implications largely related to premature death due to delayed treatment or poor post-operative outcome. Moreover, familial clustering of this disease underscores the importance of maintaining a high index of suspicion in the postmortem setting.
authors.affiliation: Regional Forensic Pathology Unit, Department of Pathology and Molecular Medicine, Queen's University and Kingston General Hospital, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada. Electronic address: 8cl58@queensu.ca.
authors.forename: Charles
authors.initials: C
authors.lastname: Leduc
authors.affiliation: Regional Forensic Pathology Unit, Department of Pathology and Molecular Medicine, Queen's University and Kingston General Hospital, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Young
authors.affiliation: Division of Rheumatology, Department of Medicine, Queen's University and Kingston General Hospital, 94 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
authors.forename: Mala G
authors.initials: MG
authors.lastname: Joneja
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parker
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D005260:Female; D049429:Forensic Pathology / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000473:pathology*; D012595:Scleroderma, Systemic / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: Diagnostic criteria; Pneumatosis intestinalis; Post-mortem; Scleroderma; Systemic sclerosis