The Antemortem Clinical Diagnosis and Postmortem Findings in Intentional Fatal Sulfuric Acid Ingestion

Abstract Oral intoxication with concentrated corrosive substances, such as sulfuric acid, is still a medical emergency, resulting in death. A 56-year-old male intentionally ingested 98% sulfuric acid and presented with diffuse abdominal pain, hypotension, and clinical signs suggestive of gastric perforation. Abdominal computed tomography showed diffuse gastric wall thickening and diffuse pneumoperitoneum. Despite intensive medical management, the patient’s condition deteriorated and resulted in death. Postmortem examination revealed extensive coagulative tissue necrosis extending along the path of corrosive ingestion with gastric perforations and secondary involvement of the peritoneum, liver, and kidneys. Histopathological evaluation demonstrated variable degrees of coagulative necrosis and vascular thrombosis across multiple respiratory and abdominal organs. The cause of death was likely attributed to shock secondary to the pathological consequences of sulfuric acid ingestion, with clinical and postmortem evidence confirming the suicidal intent. This case report described a fatal case of intentional sulfuric acid intoxication, with analysis of the antemortem clinical presentation and the associated macroscopic and microscopic postmortem findings. The postmortem examination not only confirmed the presence of antemortem findings but also ensured accurate determination of the cause, mechanism, and manner of death.