JIST

Abstract

Background:Yellow oleander poisoning(YOP) is a common cause of fatal plant poisoning in India due to its easy availability. While its clinical effects are well described in the literature, detailed autopsy and histopathological findings in fatal cases are less frequently reported.

Material and Methods: The cases for the study were collected after obtaining ethical permission and consent from patients admitted to the emergency department with a history of YOP and subsequently autopsied on death with ancillary histopathology and toxicology examination.

Results:This case series describes three fatal cases of YOP with emphasis on autopsy and histopathological findings to better understand the underlying pathophysiology of death. All three patients had taken crushed parts of the plant on an empty stomach and presented within 3-6 hours of ingestion, with severe bradycardia and hypotension suggestive of marked cardiotoxicity. Clinical severity at admission was assessed using the Poisoning Severity Score (PSS), and all three cases were classified as Grade 4, indicating extreme toxicity. All patients succumbed within a short duration of admission, despite medical intervention. On Post-mortem examination,asphyxia signs such as cyanosis and facial congestion were noted. Internally, generalised visceral congestion was found in all cases. In the heart, haemorrhages were noticed in two cases, and the mucosa of the stomach was congested with patches of submucosal haemorrhage. Histopathological examination revealed mainly nonspecific changes such as vascular congestion and inflammation in various organs. However, myocardial sections revealed subepicardialand intramyocardial haemorrhages consistent with direct toxic injury.

Conclusion:The YOP autopsy and histopathology findings are not pathognomonic, but the consistent cardiac involvement, when taken in conjunction with the severe clinical grading, supports the cardiotoxic action of cardiac glycosides and points out the value of clinicopathological correlation in such cases.