Fatal gelsemium alkaloid poisoning versus cardiovascular cause in a sudden death: a forensic case report

Gelsemium alkaloids, such as gelsemine and koumine, are highly toxic compounds that can induce rapid respiratory and cardiovascular failure. Their clinical manifestations-dizziness, ptosis, and sudden collapse-closely resemble those of acute myocardial infarction, presenting diagnostic challenges in forensic practice, especially in distinguishing between poisoning and cardiovascular events. We describe a sudden death in a middle-aged male following a restaurant meal. The decedent developed acute dizziness and eyelid drooping shortly after ingestion and died within hours despite resuscitation. Autopsy revealed pulmonary edema, systemic congestion, and coronary atherosclerosis with ischemic changes, but without acute infarction. Toxicological analyses identified gelsemine and koumine in meal remnants and biological samples, which were confirmed by LC-MS/MS with validated parameters. The concentrations detected were within reported toxic ranges, supporting a fatal exposure. On the balance of evidence, the death was most consistent with poisoning from Gelsemium alkaloids, rather than primary cardiac disease. This case emphasizes the importance of integrating toxicological confirmation with pathological findings to distinguish poisoning from cardiovascular causes in sudden deaths.