Baumgarten J, Greb I, Holz F, Nieß C, Petzel-Witt S, Birngruber Christoph G
Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, 60596, Frankfurt am Main, Germany.
Poison Control Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Forensic Sci Med Pathol. 2024 Oct 30. doi: 10.1007/s12024-024-00903-7.
Unusual findings during an autopsy may come from peculiarities in the position, shape, size, weight, consistency, smell or color of organs. The following study was triggered by an autopsy case in which an unusual blue-green discoloration of organs, which changed during the autopsy, was noticed. A review of the local autopsy database, selected cases including the antemortem clinical documentation and the literature has been performed to clarify the etiology of these conspicuous discolorations and to evaluate their diagnostic value. The study showed that certain xenobiotics may lead to such discoloration. After systemic administration of methylene blue, darkening blue-green discoloration of organs, especially the brain and heart, can be observed. In addition, the systemic administration of toluidine blue also appears to be capable of causing such discoloration. Beyond that, drugs (like Rohypnol) or other foreign substances (like detergents) containing warning colors, i.e. indigocarmin (E132) or Brilliant Blue FCF (E133) may cause discolorations of the upper gastrointestinal tract or the urinary bladder respectively. A blue-green, possibly darkening discoloration of organs during autopsy may point towards an antemortem administration of certain xenobiotics. The affected organs give an indication of the possible route of application and the type of substance. A differentiated interpretation of the etiology of such conspicuous discolorations at autopsy should only be made considering the (medical) history and, if necessary, complementary (toxicological) examinations.
尸检中发现的异常情况可能源于器官在位置、形状、大小、重量、质地、气味或颜色方面的特殊性。以下研究源于一例尸检病例，在该病例中，发现器官出现异常的蓝绿色变色，且在尸检过程中颜色发生了变化。我们对当地尸检数据库进行了回顾，选取了包括生前临床记录和文献在内的病例，以阐明这些明显变色的病因，并评估其诊断价值。研究表明，某些外源性物质可能导致这种变色。全身给予亚甲蓝后，可观察到器官，尤其是脑和心脏出现蓝绿色加深的变色。此外，全身给予甲苯胺蓝似乎也能够引起这种变色。除此之外，含有警示色的药物（如氟硝西泮）或其他外来物质（如洗涤剂），即靛蓝胭脂红（E132）或亮蓝FCF（E133），可能分别导致上消化道或膀胱变色。尸检时器官出现蓝绿色、可能加深的变色，可能提示生前使用了某些外源性物质。受影响的器官可提示可能的用药途径和物质类型。对于尸检时这种明显变色的病因，只有结合（病史）并在必要时进行补充（毒理学）检查，才能做出鉴别诊断。
