Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis.

Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.

A rare case of large organized thrombus of the tricuspid valve in a normal heart.

Thrombosis of the tricuspid valve is a very rare cardiac pathological condition, characterized by the location and formation of thrombus near the valve edges. Clinically it can be very easy to mistake it for a myxoma or an infective endocarditis. The aetiology of this condition is an alteration of coagulation, deep venous thrombosis, cardiac structural anomalies or idiopathic forms of hearts that appear structurally normal. From a clinical point of view, the thrombosis of the tricuspid, if it is not totally occlusive, causes the development of symptoms related to the reduced flow and to cardiac congestion: easy fatigue, distension of jugular veins, hepatomegaly and pulmonary congestion with dyspnoea and haemoptysis. The case we studied is of an unexpected death in a subject whose preliminary case history did not show any cardiovascular or pulmonary pathology. It was caused by a thrombosis in the tricuspid valve, originating from a deep venous thrombosis of right iliofemoral axis. In conclusion this case highlights the importance of defining precise anatomical abnormalities in forensic pathological cases.