Methamphetamine-induced profound rhabdomyolysis and myoglobin cast nephropathy: A case report and a literature review |
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| Affiliation: | 1. Section of Legal Medicine, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;2. Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;1. University of Miami Miller School of Medicine, Miami, FL, USA;2. Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA;3. New York Eye and Ear Infirmary at Mount Sinai, New York, NY, USA;4. Department of Obstetrics & Gynecology, Boston University, Boston, MA, USA;5. Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA;1. Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia;2. Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia;3. Department of Legal Medicine, Military Hospital of Tunis, Tunisia;4. Department of Legal Medicine, Trauma and Burnt Center of Ben Arous, Tunisia;1. National Group of Clinical, Psychology and Forensic Psychiatry, National Institute of Legal Medicine and Forensic Sciences, Bogotá, Colombia;2. Bogotá Regional Office (DRB in Spanish), National Institute of Legal Medicine and Forensic Sciences, Bogotá, Colombia;3. Bogotá Regional Office (DRB in Spanish), National Institute of Legal Medicine and Forensic Sciences, National University of Colombia, Bogotá, Colombia;4. Hospital Universitario Mayor – Méderi, Universidad del Rosario, Bogotá, Colombia;5. Universidad del Rosario, Bogotá, Colombia;6. Universidad de Pernambuco, Bogotá, Colombia;1. Asylum Network, Physicians for Human Rights, 256 W 38th Street, 9th Floor, New York, NY, 10018, USA;2. Physicians for Human Rights, Professor of Family Medicine, Georgetown University School of Medicine, Georgetown University, 3900, Reservoir Rd NW, Washington, DC, 20007, USA;1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Riley Children''s Hospital, Indianapolis, IN, USA;2. Research and Instructional Services Librarian, Ruth Lilly Law Library, Indiana University, Robert H. McKinney School of Law, USA;3. Indiana University, Robert H. McKinney School of Law, Office of the General Counsel, Columbus Regional Health, Columbus, IN, USA |
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| Abstract: | A 46-year-old male with a history of substance abuse was found dead in custody 30 hours post incarceration for a minor offense. The scene demonstrates the body lying in a prone position in the cell room, locked from the outside. No signs of violence were found at the scene. External examination revealed no significant injuries, except for multiple minor contusions and abrasions. The autopsy demonstrated only a moderate degree of bilateral pulmonary edema. No internal injuries were found, except for fractures in the three lower left ribs.Dark reddish-brown urine was detected in the urinary bladder. Histological examination revealed a diffuse tubular injury with intraluminal eosinophilic granular casts. The myoglobin cast demonstrated pale PAS staining with a granular appearance, Masson Trichrome staining demonstrated fuschinophilic deposits on the casts, and immunoperoxidase staining for myoglobin was strongly positive in the casts (the images will be displayed). Blood myoglobin and creatine kinase levels were elevated. These findings revealed profound rhabdomyolysis caused by several factors. Blood toxicology tests revealed lethal methamphetamine and amphetamine levels. All the findings were consistent with methamphetamine-induced severe rhabdomyolysis. Therefore, forensic pathologists should carefully search for gross and histological findings and conduct thorough laboratory investigations to diagnose this condition for complete medicolegal examination. |
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