Usefulness of Histopathological Examinations in Assessing
Cases of Fatal Poisoning with New Psychoactive Substances—Preliminary Studies
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ABSTRACT:
Investigating the cause and mechanism of death
in cases of suspected fatal poisoning with new psychoactive substances (“legal
highs”) is no different from classic post-mortem diagnostics in forensic
medicine. There is no characteristic autopsy appearance in individuals poisoned
with “legal highs”, therefore, in practice, biological material is most often
reserved for complementary histopathological and toxicological examinations. This
study aimed to assess the usefulness of microscopic examinations in assessing
cases of fatal poisoning with new psychoactive substances. The authors’
analysis of the literature and the results of histopathological examinations of
victims of “legal high” poisoning from their own practice at the Department of
Forensic Medicine and Forensic Toxicology of the Silesian Medical University in
Katowice revealed that the most common pathological or diagnostically
questionable changes are observed in the heart, kidneys, and liver. In the
heart, signs of early myocardial ischemia are often observed in the absence of
atherosclerotic changes in the coronary vessels or changes such as muscle
bridging along these vessels. Considering the relatively young age of the deceased,
it is highly probable that the pathological changes observed are related to the
use of “legal highs”, especially given their known cardiotoxicity. In the
kidneys, signs of acute tubular necrosis (ATN) are most frequently seen. These
signs are usually mild and overlap with autolytic changes, making their
assessment difficult, especially since they may be periagonal (artifacts).
Morphological changes in the liver typically represent focal hepatocyte
degeneration. Only in one case did they demonstrate signs of active
inflammation and developing fibrosis. The nature of the observed changes does
not allow for a clear connection with the use of “legal highs”, as the same
changes may be associated with metabolic disorders, obesity, alcohol abuse, or
viral hepatitis. In summary, microscopic examination of internal organ samples
collected during autopsies and post-mortem examinations of individuals who died
from legal highs is only supportive, as there is no characteristic microscopic
image that would allow for a definitive diagnosis. The extent of the
patho-logical changes observed depends primarily on age and whether the
poisoned individual was hospitalized. Infectious complications are often
observed in cases of long-term stays in intensive care units (e.g., pneumonia
associated with respirator therapy, signs of generalized infection).
Keywords:
Cause of death; Mechanism of death; Poisoning; New
psychoactive substances; Microscopic examination