A case of carbamazepine overdose with focal myocarditis

Area of Science:

• Forensic Pathology
• Cardiovascular Toxicology

Background:

• A case report detailing an autopsy of a 33-year-old female with a history of schizophrenia and bipolar disorder.
• The decedent ingested a 5-day dose of prescribed medications, including carbamazepine, leading to death approximately 8 hours later.

Observation:

• Autopsy revealed obesity, facial swelling, and significant congestion in the lungs, brain, and visceral organs.
• The heart showed no coronary atherosclerosis but microscopic examination identified focal lymphocytic myocarditis.
• Toxicological analysis confirmed a carbamazepine blood concentration of 9.9 microg/ml, with other medications below toxic levels.

Findings:

• The patient presented with focal myocarditis, potentially induced by prescribed medications, and was also obese.
• Carbamazepine overdose likely precipitated critical cardiac events, such as arrhythmia or congestive heart failure, in the setting of compromised cardiac function.

Implications:

• This case highlights the potential cardiotoxic effects of carbamazepine, especially in individuals with pre-existing cardiac conditions or risk factors like obesity.
• It underscores the importance of considering medication-induced myocarditis in overdose cases involving psychiatric patients.
• Findings suggest a complex interplay between drug toxicity, underlying cardiac pathology, and patient-specific factors in fatal overdose outcomes.