Sorrentino Antonella, Trotta Silvia, Colucci Anna Pia, Aventaggiato Lucia, Marzullo Andrea, Solarino Biagio
Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Bari, Italy.
Department of Emergency and Organ Transplantation, Division of Pathology, Medical School, Policlinico di Bari Hospital, University of Bari, Bari, Italy.
Forensic Sci Med Pathol. 2018 Jun;14(2):229-235. doi: 10.1007/s12024-018-9967-9. Epub 2018 Mar 19.
"Krokodil" is a home-made opioid drug obtained by synthesizing desomorphine from codeine and combining it with other low-cost additives. Initially introduced in the former Soviet countries, it was then imported to Western Europe as a heroin substitute. To our knowledge, this is the first report of an Italian case of lethal krokodil abuse, that occurred in a 39-year-old man, who died suddenly after transportation to the Emergency Department (ED) for hyperthermia associated with sweating, dyspnoea and tachycardia. Post-mortem examination revealed extensive necrotic ulcerative lesions on the forearms, and autopsy showed a hypertrophic heart with ample endocardial vegetation on the aortic valve and patency of the foramen ovale. Histopathological examination of the heart showed ulcero-vegetative lesions of the aortic valve with an abscess on the annulus and extension to the periaortic adipose tissue, as well as diffuse myocardial interstitial inflammatory neutrophilic infiltrates. Toxicological analysis demonstrated a desomorphine metabolite in urine. On the basis of all these findings the cause of death was ruled to be congestive heart failure caused by endocarditis and myocarditis, correlated with chronic abuse of krokodil.
“克罗科迪尔”是一种自制阿片类药物，由可待因合成去甲吗啡并与其他低成本添加剂混合制成。它最初在前苏联国家出现，后作为海洛因替代品被引入西欧。据我们所知，这是意大利首例致命性克罗科迪尔滥用病例报告，患者为一名39岁男性，因出汗、呼吸困难和心动过速伴发高热被送往急诊科后突然死亡。尸检发现前臂有广泛坏死性溃疡性病变，解剖显示心脏肥厚，主动脉瓣有大量心内膜赘生物，卵圆孔未闭。心脏组织病理学检查显示主动脉瓣有溃疡性赘生物病变，瓣环有脓肿并延伸至主动脉周围脂肪组织，以及弥漫性心肌间质炎性中性粒细胞浸润。毒理学分析在尿液中检测到去甲吗啡代谢物。基于所有这些发现，死亡原因判定为由心内膜炎和心肌炎导致的充血性心力衰竭，与长期滥用克罗科迪尔有关。
