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Multivisceral Sarcoidosis: An Unexpected Finding in a Water-Related Death

Armstrong, Erica J. MD

The American Journal of Forensic Medicine and Pathology: March 2013 - Volume 34 - Issue 1 - p 11–15
doi: 10.1097/PAF.0b013e31826627ee
Case Reports

Upon encountering a body submerged within or in close association with a watery environment, the temptation by the first responder may be to surmise that the death is probably an accidental drowning of some sort. The challenge, however, is to quickly move beyond such temptation, maintaining an open mind to other possibilities. Unearthing the circumstances surrounding a water-related death requires the collaborative efforts of groups of trained professionals including law enforcement officers, medicolegal death scene investigators, forensic scientists, and forensic pathologists. The forensic pathologist has the ultimate responsibility for the interpretation of all results arising from comprehensive autopsy and toxicological and other ancillary examinations within the context of all available investigative information, for the most accurate determination of cause and manner of death.

A water-related death is presented in which investigation into the circumstances surrounding the death and ultimately comprehensive postmortem analysis lead to the discovery of multiorgan sarcoidosis and lack of supportive evidence of drowning. This in turn facilitated the proper classification of the manner of death as natural.

From the Cuyahoga County Medical Examiner’s Office, Cleveland, OH.

Manuscript received February 16, 2012; accepted June 6, 2012.

The author reports no conflicts of interest.

Reprints: Erica J. Armstrong, MD, Cuyahoga County Medical Examiner’s Office, 11001 Cedar Ave, Cleveland, OH 44106. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.