Case ReportsBasal Subnuclear Vacuolization, Armanni-Ebstein Lesions, Wischnewsky Lesions, and Elevated Vitreous Glucose and β-Hydroxybuyrate Is It Hypothermia, Diabetic Ketoacidosis, or Both?Tse, Rexson BSc, MB, BS, FRCPA*; Garland, Jack BMed†; Kesha, Kilak MD*; Triggs, Yvonne BSc, BHB, MBChB*; Yap, Zhi MBChB‡; Stables, Simon MNZM, MBChB, DAvMed, AsFACAsM, FNZSP, FRCPA*Author Information From the *Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand; †Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia; and ‡Department of Anatomical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand. Manuscript received November 19, 2017; accepted December 7, 2017. The authors report no conflict of interest. Reprints: Rexson Tse, BSc, MB, BS, FRCPA, Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand. E-mail: email@example.com, firstname.lastname@example.org. The American Journal of Forensic Medicine and Pathology: September 2018 - Volume 39 - Issue 3 - p 279-281 doi: 10.1097/PAF.0000000000000380 Buy Metrics Abstract Hypothermia and diabetic ketoacidosis are both potentially fatal conditions, which have historically been considered to have associated pathognomonic pathologies. Hypothermia and diabetic ketoacidosis share similar pathological mechanisms, which result in metabolic derangement, with increased post mortem vitreous glucose and β-hydroxybuyrate, and are able to exacerbate and precipitate one another. Although Wischnewsky lesions are associated with hypothermia, and Armanni-Ebstein lesions and basal subnuclear vacuolization are associated with diabetic ketoacidosis, recent studies have demonstrated that there is a significant overlap between the pathological findings of these 2 conditions. We report a case of a 50-year-old woman with type 1 diabetes who was found deceased in the middle of winter. Autopsy showed Wischnewsky lesions, Armanni-Ebstein lesions, and basal subnuclear vacuolization, together with elevated vitreous glucose and β-hydroxybuyrate. The cause of death was the combined effects of hypothermia and diabetic ketoacidosis. This case highlights the overlapping clinical presentation, pathophysiology, and pathology of these 2 conditions. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.