title: Postmortem diagnosis of anaphylaxis in presence of decompositional changes.
abstract: Eosinophil and activated mast cell identification in the spleen combined with mast cell tryptase determination in postmortem serum may diagnose fatal anaphylaxis with a high degree of certainty. Mast cell tryptase measurement and significance in corpses with decompositional changes remains however an issue of controversy. Analogously, immunohistochemistry in corpses with decompositional changes may be influenced by several mechanisms, including protein alteration, antigen diffusion and unspecific antibody binding to disrupted protein structures. The authors present an autopsy case involving a 55-year-old woman who unintentionally received clarithromycin. Due to difficult in administrative procedures, the postmortem examination was performed 96 h after death. Mast cell tryptase was measured in postmortem serum from femoral, aortic and right heart blood. The obtained results were consistent with mast cell activation. Histochemistry (Pagoda Red) and immunohistochemistry (anti-tryptase antibodies) allowed splenic eosinophils and mast cells to be detected. Based on the results of all postmortem investigations, the hypothesis of anaphylaxis following accidental clarithromycin administration was formulated.
authors.affiliation: Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Medicina Legale, Modena, Italy.
authors.forename: Erjon
authors.initials: E
authors.lastname: Radheshi
authors.affiliation: Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Anatomia Patologica, Modena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Reggiani Bonetti
authors.affiliation: Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Anatomia Patologica, Modena, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Confortini
authors.affiliation: Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Medicina Legale, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Silingardi
authors.affiliation: University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced / Q000175:diagnosis*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D017291:Clarithromycin / Q000009:adverse effects; D004804:Eosinophils / Q000166:cytology; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D007150:Immunohistochemistry; D008407:Mast Cells / Q000378:metabolism*; D008508:Medication Errors; D008875:Middle Aged; D011180:Postmortem Changes; D013154:Spleen / Q000166:cytology; D053802:Tryptases / Q000097:blood*
chemical_list: D000900:Anti-Bacterial Agents; D053802:Tryptases; D017291:Clarithromycin
keywords: Anaphylaxis; Decompositional changes; Immunohistochemistry; Postmortem biochemistry; Spleen