Case details
A 35 years old female was allegedly having myalgia since five days and
was taking analgesics as self-medication. She was found dead at her own
home after few days of the onset of her symptoms. As the case was a
sudden death, it was reported to the law enforcement agencies and after
necessary inquest, the deceased was brought to our study site for medico
legal autopsy. According to her relatives, the deceased was married,
housewife, living with her two children and was not reported to be
having any underlying systemic disease or condition during her lifetime.
There was denial of any significant trauma during her life. She was
non-smoker, non-user of smokeless tobacco and non-alcoholic.
On external examination, there were ill-defined contusions on the
subject’s periorbital region, 5X3 cm contusions on both the knees, and
diffuse 6X7 cm contusion in the right thigh. These contusions could be
attributed to her staggering efforts to move around in the last few days
of her life. There was clotted blood in the perineal and vaginal region,
but no injuries were evident; it was consistent with menstrual bleed
confirmed by the statements from her family members. On complete autopsy
examination, no obvious internal injuries were detected. Both the lungs
were mildly edematous with patches of consolidation. The spleen was
grossly enlarged to approximately one kilogram in weight and 30 X 25 cm
in size. The parenchyma of the spleen was heavily congested.
We collected 20 ml of blood from the subject’s subclavian vein and 10 ml
of cerebrospinal fluid (CSF) from the occipital puncture. We collected
tissue samples using MITS technique from the subject’s key organs: brain
tissue sample through occipital and trans nasal approach, right and left
lung tissue, and liver tissue samples. Additionally, we collected spleen
tissue as it was grossly enlarged, and rectal swab. The first samples
from both the right and left lungs were collected using a new sterile
needle and placed into Brain Heart Infusion (BHI) broth for culture,
then incubated for 72 hours. The subsequent lung and other tissue
samples were placed into labeled tissue cassettes, which were
subsequently placed into a tissue jar containing 10% neutral buffered
formalin solution and then sent for histopathological examination.
Initially the tissue sections were reviewed by Hematoxylin and Eosin
(H&E) stains and later analyzed by Periodic Acid-Schiff (PAS).
About 3ml sample of blood was kept into BHI broth and incubated for
seven days. Microscopic examination of CSF sample by Gram’s stain and
India Ink preparations was performed. CSF samples were cultured in Blood
agar (BA) and Chocolate agar (CA) plates and incubated at
350C for seven days. CSF samples were incubated in two
tubes of Sabouraud dextrose agar (SDA); one tube was incubated at
350C and another tube at room temperature. Urea
hydrolysis test was performed from the colonies obtained from BA, CA and
SDA.