School of Forensic Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110122, PR China.
The Department of Pathology, the General Hospital of Northern Theater Command of Chinese People's Liberation Army, No.83 Wenhua road, Shenhe Area, Shenyang 110016, PR China.
Leg Med (Tokyo). 2022 Feb;54:101995. doi: 10.1016/j.legalmed.2021.101995. Epub 2021 Nov 19.
Methanol poisoning is responsible for high morbidity and mortality, and the elevated concentration of methanol in the body is the major criteria for forensic diagnosis of methanol poisoning. However, in cases with lower methanol concentrations, diagnosis is mainly dependent on highly variable postmortem manifestations.Herein, we report a fatal methanol poisoning cases that two subjects ingested the same amount of methanol simultaneously, yet the subject one presented only non-specific gastrointestinal and mild central nervous system symptoms, while the other subject exhibited typical toxic manifestations with the exception of visual compromise. In autopsy, subject number 1 did not show typical pathological changes caused by methanol poisoning, except for the elevated levels of methanol in body fluids. On the contrary, bilateral basal ganglia hemorrhage and necrosis caused by methanol-induced brain lesion was observed in case number 2. Due to the complex and multifactorial process of methanol intoxication, many factors, including comprehensive autopsy, quantitative detection of methanol and formic acid, and genotype analysis, participate in its metabolism and toxicity, and can impact the clinical symptoms, prognosis and postmortem manifestations. Therefore, a combination of multiple diagnosis methods may more accurately contribute to the forensic diagnosis of methanol poisoning and should be tailored on an individual basis. This case report also reviews forensic diagnosis literature on methanol poisoning to provide a reference for forensic pathologists.
甲醇中毒的发病率和死亡率都很高，体内甲醇浓度升高是甲醇中毒法医诊断的主要标准。然而，在甲醇浓度较低的情况下，诊断主要依赖于变化多端的死后表现。本文报道了一例致命的甲醇中毒病例，两名受试者同时摄入了相同量的甲醇，但其中一名受试者仅表现出非特异性胃肠道和轻度中枢神经系统症状，而另一名受试者除了视力受损外，还表现出典型的中毒症状。尸检时，1 号受试者除了体液中甲醇水平升高外，没有出现甲醇中毒引起的典型病理变化。相比之下，2 号受试者则出现了由甲醇引起的脑损伤导致的双侧基底节出血和坏死。由于甲醇中毒的过程复杂且多因素，许多因素，包括全面的尸检、甲醇和甲酸的定量检测以及基因型分析，都参与了甲醇的代谢和毒性作用，并会影响临床症状、预后和死后表现。因此，多种诊断方法的结合可能更有助于甲醇中毒的法医诊断，并应根据个体情况进行调整。本病例报告还回顾了甲醇中毒的法医诊断文献，为法医病理学家提供了参考。
