COMBINATION OF FATAL DIGOXIN POISONING WITH ENDOCARDIAL FIBROELASTOSIS

This is the first report in the forensic literature of a combination o f fatal digoxin poisoning with endocardial fibroelastosis (EFE). Typic al morphological features of EFE as the cause of clinically diagnosed cardiomyopathy were present in the autopsy of a 3-year-old girl, inclu ding cardiac hypertrophy and marked thickening of the left-sided endoc ardium, consisting of numerous elastic and collagenic fibres. After ex clusion of cardiac and cerebral causes of death, accidental digoxin in toxication was proved. Postmortem toxicological analyses by fluorescen ce polarization immuno-assay (FPIA) disclosed digoxin levels of 71 mu g/kg (femoral vein blood), 77 mu g/kg (cardiac blood), 255 and 221 mu g/kg (cardiac muscle of the right and left chamber), 163 mu g/kg (psoa s muscle), 91 mu g/kg (lung), 222 mu g/kg (liver) and 520 mu g/kg (kid ney). The results are compared with the antemortem digoxin concentrati on of 39 mu g/ml serum. The case is discussed from its unusual morphol ogical and toxicological aspects, with special consideration of possib le medical malpractice. (C) 1997 Elsevier Science Ireland Ltd.