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[Fatal therapeutic event after an injection of chlorpromazine]

S Nikolic1, J Micic, S Savic

  • 1Institute of Forensic Medicine, University School of Medicine, Belgrade.

Insights

Sudden deaths from injected medications are rare, often due to allergic reactions. This case highlights a fatal anaphylactic reaction to chlorpromazine in a psychiatric patient, emphasizing diagnostic challenges in forensic investigations.

Area of Science:

  • Forensic Pathology
  • Toxicology
  • Clinical Pharmacology

Background:

  • Parenteral administration of medications can rarely lead to accidental death, with allergic reactions being a primary concern.
  • Antibiotics are frequently cited in literature as particularly dangerous, but other drugs can also precipitate severe adverse events.
  • Establishing the cause and manner of death can be challenging due to non-specific autopsy findings and the need for comprehensive clinical correlation.

Observation:

  • A 46-year-old male with chronic schizophrenia, undergoing neuroleptic treatment, experienced sudden death approximately 30 minutes post-intramuscular injection of chlorpromazine.
  • Autopsy, microscopy, and toxicology revealed no other violent or natural causes of death.
  • Clinical presentation and circumstances surrounding the event were crucial for the investigation.

Findings:

  • The unexpected death was definitively attributed to an anaphylactic allergic reaction.
  • Chlorpromazine, the administered medication, was identified as the causative agent of the fatal reaction.
  • The case underscores the potential for severe hypersensitivity to psychotropic medications.

Implications:

  • This case highlights the importance of considering drug-induced anaphylaxis in post-mortem examinations, even with atypical presentations.
  • Forensic pathologists must be vigilant in evaluating medication histories and potential adverse drug reactions.
  • Accurate determination of cause of death is critical for addressing potential medical malpractice claims.

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