Unique Skin Lesions in Suicidal Intravenous Pentobarbital Overdose: A Case Report and Literature Review

Background: Suicide is a significant public health concern, with certain professions such as veterinarians, exhibiting higher suicide rates. Among the common methods of suicide in veterinarians, self-poisoning with the euthanasic product pentobarbital is notably prevalent which can be explained by the accessibility of this drug. Methods: This case report examines the death of a 27-year-old female veterinarian who died from an overdose of intravenously administered pentobarbital. A review of the literature and a search of the database of the Department of Forensic Medicine at UZ Leuven for similar cases was performed. Results: In total, 21 cases of suicidal intoxications with barbiturates, primarily pentobarbital, were included. The 27-year-old veterinarian presented with distinctive skin lesions characterized by marbling, necrosis, and blister formation around the infusion site. These skin manifestations are seen only in cases of intravenous administration of pentobarbital. Common factors in these cases such as anatomical distribution are analyzed and a potential mechanism of origin is proposed. Conclusion: This article discusses the significance of unique skin lesions in forensic investigations, emphasizing their potential role as a pathognomonic sign for intoxications involving barbiturates.