Combination of fatal digoxin poisoning with endocardial fibroelastosis

This is the first report in the forensic literature of a combination of fatal digoxin poisoning with endocardial fibroelastosis (EFE). Typical morphological features of EFE as the cause of clinically diagnosed cardiomyopathy were present in the autopsy of a 3-year-old girl, including cardiac hypertrophy and marked thickening of the left-sided endocardium, consisting of numerous elastic and collagenic fibres. After exclusion of cardiac and cerebral causes of death, accidental digoxin intoxication was proved. Postmortem toxicological analyses by fluorescence polarization immuno-assay (FPIA) disclosed digoxin levels of 71 mu g/kg (femoral vein blood), 77 mu g/kg (cardiac blood), 255 and 221 mu g/kg (cardiac muscle of the right and left chamber), 163 mu g/kg (psoas muscle), 91 mu g/kg (lung), 222 mu g/kg (liver) and 520 mu g/kg (kidney). The results are compared with the antemortem digoxin concentration of 39 mu g/ml serum. The case is discussed from its unusual morphological and toxicological aspects, with special consideration of possible medical malpractice. (C) 1997 Elsevier Science Ireland Ltd.