The case of a 66-year-old woman with a history of hypertension, fibromyalgia and myasthenia gravis diagnosed 20 years earlier came to the forensic pathology service.
She continued on chronic anti-hypertensive treatment with amikacin (10 mg/24 h), furosemide (40 mg/24 h) and losartan potassium (50 mg/24 h), anxiolytic - antidepressant with oral duloxetine (30 mg/24 h).
One week before death, the patient presented to the emergency department with catarrhal symptoms and was treated with ciprofloxacin and cysteine, with improvement of the respiratory symptoms.
Two days before the patient died, he consulted again in the emergency department because of a general weakness that was attributed to antibiotic treatment and the suspension of the treatment was indicated.
Clinical manifestations of headache and/or other symptoms of neurological focality were not recorded.
The patient died suddenly witnessed and her husband reported dyspnea as the only symptom prior to death.
During autopsy, the most notable findings were as follows:
Size 149 cm, weight 80 kg and Body Mass Index 36 kg/m2, corresponding to obesity type II.
Other notable findings of the external examination were hirsutism, scarring secondary to thymectomy for the treatment of myasthenia gravis and lower limb edema.
As external signs of cause was found a recent right glue hematoma compatible with the fall that suffered during the perimortal period and with the sitting position on the ground where it was found during the act of lifting the corpse.
The most relevant findings of the internal examination were coagulated hemopericardium of 200 g, the heart weighed 400 g (expected weight 320 g) and observed a rupture of 0.5 cm in the anterior third of the left ventricle marked by descending coronary infarction.
In the skull the presence of frontal internal hyperostosis stood out, less marked in the parietal area.
The thickness of the unaffected diploe was 8 mm while in the areas of hyperostosis the thicknesses were between 2.3 mm. In addition, multiple nodular meningiomas were found, most of them being calcified sinus.
A slight depression of the surface of both frontal lobes was observed in the brain.
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The rest of the autopsy findings were not significant and the results of the toxicological analytical study were negative.
Histopathological study was consistent with macroscopic data of frontal internal hyperostosis and meningiomas were calcified psamomatosis.
