@article{ref1,
title="When a death apparently associated to sexual assault is instead a natural death due to idiopathic hypereosinophilic syndrome: the importance of gamma-hydroxybutyric acid analysis in vitreous humor",
journal="Legal medicine (Elsevier)",
year="2017",
author="Busardò, Francesco Paolo and Portelli, Francesca and Montana, Angelo and Rotolo, Maria Concetta and Pichini, Simona and Maresi, Emiliano",
volume="26",
number="",
pages="92-97",
abstract="We here report a case involving a 21-year-old female, found dead in a central square of a city in the south of Italy. Initial evidences and circumstances were suggestive of a death associated with a sexual assault. Two peripheral blood and two vitreous humor samples were collected for the purpose of gamma-hydroxybutyric acid (GHB) testing from the dead body at two different post-mortem intervals (PMIs): approximately 2 (t0) and 36 (t1) hours. The obtained results showed that, between t0 and t1, there was an increase of GHB concentrations in peripheral blood and vitreous humor of 66.3% and 8.1%, respectively. This case was the first evidence of GHB post mortem production in a dead body and not in vitro, showing that vitreous humor is less affected than peripheral blood in GHB post-mortem production. The value detected at t1 in peripheral blood (53.4µg/mL) exceeded the proposed cut-off and if interpreted alone would have led to erroneous conclusions. This was not the case of vitreous humor GHB, whose post-mortem increase was minimal and it allowed to exclude a GHB exposure. Only after a broad forensic investigation including a complete autopsy, serological, histological, toxicological and haematology analyses, a diagnosis of idiopathic hypereosinophilic syndrome, a myeloproliferative disorder characterized by persistent eosinophilia associated with damage to multiple organs, was made and the cause of death was due to a pulmonary eosinophilic vasculitis responsible for an acute respiratory failure.<br><br>Copyright © 2017 Elsevier B.V. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1344-6223",
doi="10.1016/j.legalmed.2017.04.001",
url="http://dx.doi.org/10.1016/j.legalmed.2017.04.001"
}