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
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 (53.4 µg/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 postmortem 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