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Wischnewski Spots in a Case of Hyperosmolar Hyperglycemic State
Jonathan K Lai1, Tyler B M Hickey
1From the Department of Pathology, McGill University Health Centre, Montreal, Quebec.
The American Journal of Forensic Medicine and Pathology
|April 24, 2023
Summary
Wischnewski spots, typically linked to hypothermia, can also appear in non-hypothermic conditions. This case highlights their presence in hyperosmolar hyperglycemic state, expanding their differential diagnosis.
Area of Science:
- Forensic Pathology
- Gastroenterology
Background:
- Wischnewski spots are lesions found in gastric mucosa.
- Historically associated with hypothermia, they've also been observed in diabetic ketoacidosis, pancreatitis, and burns.
Purpose of the Study:
- To report a case of Wischnewski spots in a patient without hypothermia.
- To discuss the pathophysiology and differential diagnosis of Wischnewski spots.
Main Methods:
- Case report of a middle-aged woman with type 2 diabetes.
- Autopsy with histological examination of gastric mucosa.
- Biochemical analysis of vitreous humor and femoral blood.
Main Results:
- Wischnewski spots observed in gastric mucosa despite absence of hypothermia.
- Histology showed brown-black pigmentations without neutrophilic infiltration.
- Biochemical analysis revealed hyperglycemia, low ketone bodies, pseudohyponatremia, and prerenal azotemia consistent with hyperosmolar hyperglycemic state.
Conclusions:
- Wischnewski spots are not exclusive to hypothermia.
- Hyperosmolar hyperglycemic state is a potential condition associated with Wischnewski spots.
- These findings broaden the differential diagnosis for Wischnewski spots.
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