[Fatal therapeutic event after an injection of chlorpromazine]

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.