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A rare autopsy case of traumatic rhabdomyolysis associated with intermittent assault
Fumiko Chiba1, Yohsuke Makino1, Ayumi Motomura2
1Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-8670, Japan.
Abstract:
Traumatic rhabdomyolysis generally occurs after severe blunt trauma and is acute in onset, associated with severe disease, and potentially lethal. Accordingly, diagnosis of traumatic rhabdomyolysis in patients without massive subcutaneous or intramuscular hemorrhage is difficult, especially in the postmortem period, which is limited in terms of the availability of biochemical examination tools and accurate history of illness. To the best of our knowledge, there are no previous reports of death from traumatic rhabdomyolysis among individuals who did not pursue medical consultation. A previously healthy man in his early sixties had been punched and kicked several times in the previous 2months, but he had not gone to a hospital. He suddenly lost consciousness at his workplace approximately 5days after the most recent assault, and cardiopulmonary arrest occurred when the emergency service arrived. He died the same day, and a medicolegal autopsy was performed. Although several sites of minor subcutaneous and muscle hemorrhage were observed, the cause of death was unclear upon macroscopic assessment. Immunohistochemical staining revealed acute renal failure caused by rhabdomyolysis. We herein report a rare case of fatal traumatic rhabdomyolysis, seemingly associated with minor and apparently nonlethal muscle injury.
Insights
Traumatic rhabdomyolysis can be fatal even with minor injuries. This case highlights the difficulty in diagnosing this condition postmortem, especially when external signs of trauma are minimal.
Area of Science:
- Forensic Pathology
- Toxicology
- Nephrology
Background:
- Traumatic rhabdomyolysis typically follows severe blunt trauma and can be lethal.
- Diagnosis is challenging, particularly postmortem, due to limited diagnostic tools and patient history.
- Fatal traumatic rhabdomyolysis without significant external hemorrhage is rarely reported.
Purpose of the Study:
- To report a rare case of fatal traumatic rhabdomyolysis.
- To emphasize the diagnostic challenges in cases with minimal external trauma.
- To highlight the potential lethality of rhabdomyolysis following seemingly minor assaults.
Main Methods:
- Medicolegal autopsy with macroscopic and microscopic examination.
- Immunohistochemical staining for diagnosing acute renal failure secondary to rhabdomyolysis.
- Review of clinical history and circumstances surrounding the death.
Main Results:
- A previously healthy man died from acute renal failure caused by rhabdomyolysis.
- The rhabdomyolysis was associated with multiple assaults but only minor subcutaneous and muscle hemorrhage.
- The cause of death was not apparent on initial macroscopic autopsy findings.
Conclusions:
- Traumatic rhabdomyolysis can be a cause of death even with seemingly minor muscle injury.
- Immunohistochemistry is crucial for diagnosing rhabdomyolysis in postmortem examinations with limited clinical data.
- This case underscores the importance of considering rhabdomyolysis in unexplained deaths following physical assault.