Fatal poisoning by butane sniffing: A forensic analysis and immunohistochemical detection of myocardial hypoxic damage

• Published in: Journal of forensic and legal medicine 2017-10, Vol.51, p.57-62
• Main Authors: Ventura, Francesco, Barranco, Rosario, Landolfa, Maria Celeste, Gallo, Massimo, Castiglione, Andrea Gianelli, Orcioni, Giulio Fraternali, De Stefano, Francesco
• Format: Article
• Language: English
• Subjects: Adult; Butane; Butanes - poisoning; Fibronectins - metabolism; Forensic immunohistochemistry; Humans; Hypoxia - chemically induced; Hypoxia - pathology; Immunohistochemistry; Inhalant Abuse; Lung - pathology; Male; Myocardium - metabolism; Myocardium - pathology; Sudden death; Troponin C - metabolism; Volatile substance abuse; Young Adult
• ISSN: 1752-928X; 1878-7487
• DOI: 10.1016/j.jflm.2017.07.019

Although less widespread than twenty years ago, inhalant abuse remains an on-going problem, whose incidence among U.S. teenagers and young adults ranges from 10 to 15%. Death due to the inhalation of vapor from halogenated hydrocarbons is a well-known phenomenon, yet few cases of fatal butane-gas poisoning have been described. Many cases of volatile substance abuse in prison populations have been reported: drug-addicted inmates often resort to this alternative practice when unable to get their habitual drugs of abuse. A similar pattern occurs especially among adolescents. The study herein described was conducted including all cases of fatal acute intoxication of butane gas examined from 2007 to 2015 at the Institute of Legal Medicine and Forensic Sciences of the University of Genoa. In the absence of overt and specific macroscopic and histological findings indicating cause and pathological mechanism of death, we aimed to assess whether recent cardiac lesions were detectable by way of immunohistochemical (IHC) analysis. Specifically, fibronectin and troponin C expression in myocardial tissues were investigated in deaths from acute butane-gas poisoning so as to better define the underlying pathological mechanisms. IHC findings were indicative of hypoxic cardiac damage. In all cases, positivity to fibronectin and mildly to moderately reduced troponin C expression in cardiac muscle cells were immunohistochemically ascertained. •A complete forensic analysis of four cases of fatal butane poisoning.•Immunohistochemical study of cases of fatal butane intoxication.•Fibronectin and troponin C expression in myocardial tissues.•Butane gas was responsible for the global myocardial hypoxia.•Immunohistochemistry takes on a key role for demonstrating such lesions.