Carbon monoxide poisoning without cherry-red livor

Carbon monoxide (CO) poisoning typically causes so-called cherry-red livor of the skin and viscera. The authors report a case of CO poisoning in which cherry-red livor did not develop. The decedent was a 75-year-old white man who was found dead in his car during a cold winter. Blood CO saturation wa s 86%. The death was attributed to CO poisoning, and the manner of death wa s designated suicide. The curious absence of cherry-red livor was studied. The decedent's tissue and blood specimens were tested at different temperat ures. There was no tendency for either type of specimen to develop cherry-r ed color at cold or warm temperatures. The antemortem response of the skin to cold possibly sequestered CO-saturated blood in the cadaver. As regards the viscera, there are other proteins to which CO can bond, and possibly th ese proteins contribute to the development of visceral cherry-red livor. In this case, the absence of cherry-red livor could have led to misclassifica tion of the cause and manner of death. The medicolegal and social consequen ces of such mis classification can be significant, and psychiatric history, which may be useful to surviving family members, could be lost.