Fire exposure after lethal hypothermia.

A 49-year-old woman was found dead in her apartment after a fire began in her building. During the forensic autopsy, 3rd to 4th degree burns were found on the woman's body, but there were no indications that she was alive when the fire started. Interestingly, hemorrhagic gastric mucosa erosions, as well as bloody contents in the esophagus, stomach, and intestines, were observed. However, the source of the bleeding could not be found. The cause of death was therefore determined to be hypothermia with postmortem fire exposure. The cause of the hypothermia could possibly have been high internal blood loss. The organs showed early signs of putrefaction. It was theorized that the woman had not died immediately before the fire began, but rather a few days before. Examination of heat shock proteins (HSPs) to evaluate premortem thermal influences did not reveal HSP 27, 60, or 70 expression in renal tissue, possibly because of the putrefaction. However, Sudan staining of this tissue revealed a fatty degeneration of renal tubular cells. Opposing temperature influences, as in this case, are rather rare and require thorough investigations.