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Postmortem Findings After Anaphylactic Reactions to Drugs in Turkey

Yilmaz, Riza MD*; Yuksekbas, Ozlem MD*; Erkol, Zerrin MD†; Bulut, Erkut R. MD*; Arslan, Murat N. MD*

American Journal of Forensic Medicine & Pathology: December 2009 - Volume 30 - Issue 4 - pp 346-349
doi: 10.1097/PAF.0b013e3181c0e7bb
Original Article

Aims: To determine the frequency of anaphylactic deaths at autopsies performed in Turkey between January 2001 and June 2006 and to review the circumstances of death and autopsy findings.

Methods: The Council of Forensic Medicine database in Istanbul was searched for anaphylactic deaths. Postmortem reports and medical records were reviewed to determine the circumstances of death. Data about basic demographics, medical history, drugs responsible for allergic reactions, and pathologic findings at autopsy were collected.

Results: A total of 36 anaphylactic deaths from drugs were identified for the study period. Death was due to antibiotics in 26 cases, analgesics in 7 cases, an intraoperative drug in 1 case, an H2 receptor in 1 case, and intravenous contrast medium in 1 case. Out of 36 cases, 19 were male and 17 female. They were aged between 1 and 74 years with the median age of 26.7 years. Death occurred within 1 hour of the onset of anaphylaxis in 27 cases. Findings at autopsy included nonspecific pulmonary edema and congestion, upper airway edema, cerebral hypoxia, and cutaneous edema. Serum tryptase levels were not measured in all cases.

Conclusion: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. When serum tryptase levels cannot be determined, in the presence of typical clinical records, eye witness reports and autopsy findings can be useful diagnostic aids.

From the *Council of Forensic Medicine, Istanbul, Turkey; and †Department of Forensic Medicine, Abant Izzet Baysal University School of Medicine, Bolu, Turkey.

Manuscript received February 17, 2007; accepted July 25, 2007.

Reprints: Riza Yilmaz, MD, Council of Forensic Medicine, PK 16 Sirinevler, Istanbul, Turkey. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.