Suspected Fatal Cade Oil Poisoning Following Dermal Exposure in an Infant: Autopsy Findings and a Structured Forensic Causality Assessment

Background: Cade oil, derived from Juniperus oxycedrus, is used in traditional medicine and contains phenolic compounds capable of causing systemic toxicity. Dermal exposure may result in severe toxicity in young children. Medico-legal interpretation can be challenging when toxicological confirmation is unavailable. Case Presentation: We report a 6-month-old male infant who developed neurological deterioration, respiratory distress, and hemodynamic collapse following reported dermal application of cade oil. The child had experienced respiratory symptoms followed by vomiting and diarrhea before the reported exposure. Despite intensive care, including peritoneal dialysis for acute renal failure, he died within 24 hours of admission. Post-mortem examination revealed pulmonary edema, multiorgan congestion, and bilateral renal cortical hemorrhagic suffusions. Histological examination demonstrated acute tubular necrosis with congestive changes in other organs. No toxicological analysis was available. The clinical and pathological findings were compatible with severe systemic toxicity but were not specific for a toxic etiology. Infection, dehydration/hypovolemia, and shock-related organ injury remained plausible competing mechanisms. Causal interpretation therefore relied on structured integration of exposure history, chronology, biological plausibility, clinical evolution, autopsy findings, and competing explanations. Conclusion: The temporal relationship, biological plausibility, and compatible clinicopathological findings support a probable contribution of systemic cade-oil toxicity to the fatal outcome. However, definitive etiological attribution was limited by the absence of toxicological confirmation and the presence of pre-existing illness. This case illustrates the importance of transparent forensic reasoning when suspected toxic exposure occurs in the setting of incomplete analytical evidence and competing causes.