Fatal Leguminous Aspiration Diagnosed at Postmortem Examination: A Rare Cause of Sudden Death in a Previously Healthy...

Aspiration pneumonitis due to vegetative foreign material is a rare and underrecognized cause of sudden death, particularly in previously healthy individuals without conventional predisposing risk factors. We report the case of a 52-year-old man who was found unconscious at home and declared dead on arrival at the emergency department. Organs were received for medicolegal histopathological evaluation following external examination at the scene. Gross examination of the lungs revealed firm parenchyma with patchy consolidation and smooth, glistening pleural surfaces. Histopathological examination demonstrated alveolar edema, hemorrhage, and acute inflammatory infiltrates. The key diagnostic finding was the presence of multiple round-to-oval structures within a bronchiolar lumen, with lobulated outlines, optically empty centers, and a periodic acid-Schiff-positive outer coating consistent with leguminous particles, most likely lentil fragments. The particles were surrounded by foamy macrophages, supporting antemortem aspiration. Ziehl-Neelsen staining was negative for acid-fast bacilli, and no granulomatous inflammation was identified. The cause of death was certified as aspiration pneumonitis due to lentil aspiration. This case highlights the need for meticulous histopathological examination of the airways during medicolegal evaluation, as food-related aspiration remains an underappreciated cause of sudden death in forensic settings where traditional risk factors are absent.