From crime scene investigation to the identification of the cause of death: A muscle-popping case report

The goal of this paper is to highlight the importance of a careful methodological multidisciplinary approach during the crime scene analysis in the cases of death linked to fatal intramuscular illicit drug administration. This case report describes the case of a 55-year-old man found dead by his wife in his covered garage. At the external examination, on left gluteal super-external quadrant, three acupuncture signs, surrounded by a purplish halo, were found; on the right gluteal super-external quadrant, an old acupuncture sign was also noted. At the crime scene investigation a 10-mL syringe with the cap inserted was found; not far, a little blood stain was noted near the body together with two paper handkerchiefs with very little dried blood stains; finally, a white plastic container with a label identifying it as DONA® (glucosamine sulfate), a lid with several incisions, and a white powder packaging were found. A complete autopsy was performed and no macroscopic cause of death was defined. Further analyses were performed in order to identify the cause of death, performing a multidisciplinary approach with toxicological and histological examinations. The cause of death was a fatal arrhythmia due to the cardiotoxic effects of cocaine assumption. The presented case will impact the forensic community by pointing out the difficulty to identify the cause of death in complex cases: for example, the use of unusual way for illicit drug administration requests a multidisciplinary approach in order to define a specific cause of death.