Fatal aconitine intoxication or thyroid storm? A case report

• Published in: Legal medicine (Tokyo, Japan) Vol. 14; no. 3; pp. 154 - 156
• Main Authors: Arlt, E.M, Keller, T, Wittmann, H, Monticelli, F
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.05.2012
• Subjects: Aconitine; Aconitine - blood; Aconitine - poisoning; Aconitum napellus; Adolescent; Autopsy; Fatal Outcome; Female; Humans; Internal Medicine; Intoxication; Thyroid Crisis - diagnosis; Thyroid Crisis - mortality; Thyroid storm; Thyroid storm; Intoxication; Aconitine
• ISSN: 1344-6223; 1873-4162
• DOI: 10.1016/j.legalmed.2012.01.003

Abstract The case of a female in the latter half of her teens found dead in her father’s apartment is reported. A glass containing liquid and plant remnants was found at the death scene. There were no indications of any intervention or the application of force by a third party. Autopsy showed unremarkable findings. Toxicological investigations revealed lethal doses of aconitine, a highly poisonous alkaloid and the major active compound of Aconitum napellus , in all specimens. Plant remnants were identified as A. napellus leaves by a botanist and toxicological examination of the liquid in the glass on site showed extremely high concentrations of aconitine. Additionally, laboratory results revealed that the young female was suffering from thyrotoxicosis factitia, an uncommon form of hyperthyroidism caused by misuse or overdosing of thyroid hormones in order to loose weight. A rare but serious and often fatal complication of hyperthyroidism is thyroid storm. Eventually the condition of thyroid storm due to thyrotoxicosis factitia could have contributed to the woman’s death from aconitine poisoning.