title: Rare cause of natural death in forensic setting: hemophagocytic syndrome.
abstract: We report about the case of a sudden unexpected death of a 25-year-old male suffering from infectious disease. An autopsy was ordered with no final premortem diagnosis. Microscopic and microbiological examination revealed a pneumococcal bronchopneumonia and hemophagocytic lesions in the bone marrow. After integrating clinical and autopsy reports as well as additional postmortem investigations, the cause of death was found to be infectious-triggered hemophagocytic syndrome (HPS) with a final cytokine storm. This seems to be the first reported fatal case of a reactive form of HPS associated to Streptococcus pneumoniae to the best of our knowledge. HPS is a dangerous hyperinflammation with highly characteristic, but nonspecific, laboratory findings and symptoms. Autopsies in such cases must be carefully performed and include systematic tissue sampling done by an experienced pathologist.
authors.affiliation: Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany. benjamin.ondruschka@medizin.uni-leipzig.de.
authors.forename: B
authors.initials: B
authors.lastname: Ondruschka
authors.affiliation: Centre of Histopathology, Chemnitz, Unritzstraße 21, 09117, Chemnitz, Germany.
authors.forename: J-O
authors.initials: JO
authors.lastname: Habeck
authors.affiliation: Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hädrich
authors.affiliation: Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Dreßler
authors.affiliation: Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bayer
mesh_terms: D000328:Adult; D001996:Bronchopneumonia / Q000382:microbiology; D003645:Death, Sudden / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis*; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications
chemical_list: D015850:Interleukin-6
keywords: Bone marrow; Cytokine storm; Hemophagocytic syndrome; Histopathology; Infectious disease; Sudden death