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肺毛细血管炎作为致死性弥漫性肺泡出血的一个病因。

Pulmonary capillaritis as a cause of lethal diffuse alveolar hemorrhage.

作者信息

Suess Christine, Schwartz Melanie, Hausmann Roland

机构信息

Institute of Legal Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland.

出版信息

Int J Legal Med. 2023 Sep;137(5):1481-1487. doi: 10.1007/s00414-023-03056-4. Epub 2023 Jul 4.

Abstract

Lethal pulmonary hemoptysis is a common finding in forensic medicine. Since hemoptysis does not necessarily occur before death and its previous symptoms are usually unspecific, indicative signs or findings at the site of a corpse may be completely absent. If lethal acute alveolar hemorrhage is found in the post-mortem examination, a differential diagnosis should be made for traumatic, substance-related, infectious, or organic causes. Cocaine-associated pulmonary hemorrhage and drug reactions are in the foreground. For organic causes, autoimmune diseases should be considered in addition to cardiac, haematological, and infectious causes. The following two cases show similarities both in the sudden, unexpected deaths and the anamnesis of the two deceased women. One of the deceased received a Corona vaccination a few months earlier. In each case, the post-mortem examination revealed an acute diffuse pulmonary hemorrhage caused by acute inflammation of the lung capillaries. This case presentation demonstrates the necessity of a complete autopsy including toxicological and histological analyses. The documentation and publication of rare causes of death are essential for medical research and practice in order to critically consider and discuss the possibility of to date unknown associations in similar cases.

摘要

致死性咯血是法医学中常见的发现。由于咯血不一定发生在死亡之前,且其先前症状通常不具有特异性,尸体部位可能完全没有指示性体征或发现。如果在尸检中发现致死性急性肺泡出血,应针对创伤性、物质相关、感染性或器质性原因进行鉴别诊断。可卡因相关性肺出血和药物反应最为突出。对于器质性原因,除心脏、血液学和感染性原因外,还应考虑自身免疫性疾病。以下两例在两名已故女性的突然意外死亡和病史方面都有相似之处。其中一名死者在几个月前接种了新冠疫苗。在每例中,尸检均显示由肺毛细血管急性炎症引起的急性弥漫性肺出血。本病例展示了进行包括毒理学和组织学分析在内的完整尸检的必要性。记录和公布罕见死因对于医学研究和实践至关重要,以便在类似病例中审慎考虑和讨论迄今未知关联的可能性。

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