Acute thallium poisoning: An autopsy case report and review of the literature

We report a case of death due to thallium (Tl) poisoning and discuss the findings with reference to the literature on Tl poisoning. A woman in her 20 s with a history of asthma developed symptoms such as coughing, vomiting, and fatigue, and visited a primary-care physician. She was rushed to another hospital on suspicion of an asthma attack, but her condition suddenly worsened and she died 3 days later. Postmortem computed tomography (CT) performed immediately before autopsy revealed high-density foreign material in the stomach and intestines. Autopsy findings revealed severe edematous changes under the skin and in various organs, and multi-organ failure was identified. In addition, large amounts of pleural effusion, severe pulmonary edema, pulmonary hemorrhage, and hyaline membrane formation in the lung tissue suggested acute respiratory distress syndrome (ARDS). Tl was detected in the blood at concentrations of 28.39-36.77 mg/L, about three times the lethal concentration. The cause of death in this case was thus determined to be ARDS caused by acute Tl poisoning. Many reports have described acute Tl poisoning affecting the lungs, as in this case. Generally, Tl is rarely included in toxicological analyses, but in cases such as this where ARDS is accompanied by severe pulmonary edema and a highly radio-opaque foreign material has been identified in the stomach or intestines on CT, Tl analysis using inductively coupled plasma mass spectrometry or other methods may facilitate determination of the cause of death.