Fatal brodifacoum rodenticide poisoning: Autopsy and toxicologic findings

This report details the pathologic and toxicologic findings in the case of a 15-year-old girl who deliberately and fatally ingested brodifacoum, a com monly used rodenticide. The mechanism of death, massive pulmonary hemorrhag e, has not been previously reported. Brodifacoum was quantitated in liver, spleen, lung, brain, bile, vitreous humor, heart blood, and femoral blood u sing HPLC with fluorescence detection. The highest brodifacoum concentratio ns were detected in bile (4276 ng/mL) and femoral blood (3919 ng/mL). No br odifacoum was detected in brain or vitreous humor. A brodifacoum concentrat ion of 50 ng/g was observed in frozen liver while formalin fixed liver exhi bited a concentration of 820 ng/g. A very high blood:liver brodifacoum conc entration ratio suggested acute poisoning but the historical and pathologic findings suggested a longer period of anticoagulation. Though most cases o f brodifacoum poisoning in humans are non-fatal, this compound can be deadl y because of its very long half-life. Forensic pathologists and toxicologis ts should suspect superwarfarin rodenticides when confronted with cases of unexplained bleeding. Anticoagulant poisoning can mimic fatal leukemia or i nfectious diseases such as bacterial sepsis, rickettsioses, plague, and lep tospirosis. A thorough death scene investigation may provide clues that a p erson has ingested these substances.