The incident at Tuol Chrey: pathologic and toxicologic examinations of a casualty after chemical attack

The results of the pathologic and toxicologic examinations of specimens from a casualty who died several weeks after a chemical attack in Kampuchea are discussed. While the effects of tricothecene mycotoxins have been described in domestic and experimental animals, there is a paucity of information about the pathologic effects of these toxins in humans. The possible effects of endemic diseases such as falciparum malaria, viral hepatitis, and nutritional deficiencies, as well as of the sudden, unexpected death syndrome among refugees from Southeast Asia, have been reviewed. If the results of the histologic examinations in this case are considered alone, it is not possible to establish a cause-effect relationship. However, the circumstances of injury, the relationship of pathologic findings to the studies of experimental animals, and the results of the toxicologic examinations of environmental and biologic specimens indicate that the combinations of tricothecene mycotoxins detected are not consistent with natural occurrence and provide evidence that the pathologic effects are related to a toxic agent.