Osawa Motoki, Satoh Fumiko, Horiuchi Hidekazu, Tian Wei, Kugota Nobuko, Hasegawa Iwao
Department of Forensic Medicine, Tokai University Faculty of Medicine, Boseidai, Isehara, Kanagawa 259-1193, Japan.
Leg Med (Tokyo). 2008 May;10(3):143-7. doi: 10.1016/j.legalmed.2007.10.002. Epub 2007 Nov 26.
This report documented three autopsy cases involving fatal shock during intravenous injection of therapeutic and diagnostic agents in a hospital setting. For postmortem diagnosis, clinical laboratory parameters for anaphylaxis, specificity of antibodies for allergens and mast cell numbers in tissue sections were examined. Elevated plasma tryptase levels were evident in the three adult males; two of the three victims displayed elevated IgE levels. However, immunoassay failed to detect antibodies specific to the relevant agent. Double immuno-staining was performed employing anti-tryptase and anti-chymase monoclonal antibodies in order to count mast cells in lung sections. Increased numbers of mast cells were observed in anaphylactic tissues, which was particularly true for chymase-positive cells, in comparison with tissues associated with acute traumatic deaths. In addition to findings at autopsy, positive data obtained by laboratory examinations and immunohistochemical analyses indicated that fatal systemic anaphylaxis occurred during intravenous injection of clinical agents.
本报告记录了3例在医院环境中静脉注射治疗和诊断药物期间发生致命性休克的尸检病例。为进行死后诊断，检查了过敏反应的临床实验室参数、过敏原抗体特异性以及组织切片中的肥大细胞数量。3名成年男性的血浆类胰蛋白酶水平明显升高；3名受害者中有2人IgE水平升高。然而，免疫测定未能检测到针对相关药物的特异性抗体。采用抗类胰蛋白酶和抗糜蛋白酶单克隆抗体进行双重免疫染色，以计数肺组织切片中的肥大细胞。与急性创伤性死亡相关的组织相比，在过敏组织中观察到肥大细胞数量增加，对于糜蛋白酶阳性细胞尤其如此。除尸检结果外，实验室检查和免疫组化分析获得的阳性数据表明，静脉注射临床药物期间发生了致命性全身性过敏反应。
