Usefulness of Histopathological Examinations in Assessing Cases of Fatal Poisoning with New Psychoactive Substances—Preliminary Studies

Investigating the cause and mechanism of death in cases of suspected fatal poisoning with new psychoactive substances (“legal highs”) is no different from classic post-mortem diagnostics in forensic medicine. There is no characteristic autopsy appearance in individuals poisoned with “legal highs”, therefore, in practice, biological material is most often reserved for complementary histopathological and toxicological examinations. This study aimed to assess the usefulness of microscopic examinations in assessing cases of fatal poisoning with new psychoactive substances. The authors’ analysis of the literature and the results of histopathological examinations of victims of “legal high” poisoning from their own practice at the Department of Forensic Medicine and Forensic Toxicology of the Silesian Medical University in Katowice revealed that the most common pathological or diagnostically questionable changes are observed in the heart, kidneys, and liver. In the heart, signs of early myocardial ischemia are often observed in the absence of atherosclerotic changes in the coronary vessels or changes such as muscle bridging along these vessels. Considering the relatively young age of the deceased, it is highly probable that the pathological changes observed are related to the use of “legal highs”, especially given their known cardiotoxicity. In the kidneys, signs of acute tubular necrosis (ATN) are most frequently seen. These signs are usually mild and overlap with autolytic changes, making their assessment difficult, especially since they may be periagonal (artifacts). Morphological changes in the liver typically represent focal hepatocyte degeneration. Only in one case did they demonstrate signs of active inflammation and developing fibrosis. The nature of the observed changes does not allow for a clear connection with the use of “legal highs”, as the same changes may be associated with metabolic disorders, obesity, alcohol abuse, or viral hepatitis. In summary, microscopic examination of internal organ samples collected during autopsies and post-mortem examinations of individuals who died from legal highs is only supportive, as there is no characteristic microscopic image that would allow for a definitive diagnosis. The extent of the patho-logical changes observed depends primarily on age and whether the poisoned individual was hospitalized. Infectious complications are often observed in cases of long-term stays in intensive care units (e.g., pneumonia associated with respirator therapy, signs of generalized infection).