J-LSMS 2014 | Annual Archive

Journal of the Louisiana State Medical Society

P athology I mage of the M onth

Sudden Unexplained Death in a Young Adult With Known Alcohol Abuse

Robin R. McGoey, MD; William P. Newman, MD

A 35-year-old, recently deceased woman with a medical history known only to include Hepatitis C and al- cohol abuse was transferred to the autopsy service for an unrestricted autopsy under coroner authorization following a sudden unexplained death. External examination revealed marked scleral icterus and cutaneous jaundice. Internal examination was remarkable for 3 liters of ascitic fluid and established cirrhosis with a micronodular pattern (nodules all <0.3cm in diameter). Numerous, small, firm vegetations were identified along the edges of the tricuspid, mitral, and aortic valves. There was no obvious necrosis or tissue destruc- tion seen grossly. Zones of prominent myocardial discoloration and hemorrhage were seen in all regions (anterior, lateral, and posterior) of the left ventricular myocardium, as well as within the interventricular septal myocardium. Multiple punctate lesions, up to 2 cm in diameter with a greenish hue and associated with tissue necrosis were seen overlying the cerebral cortex, as well as within the intracerebral parenchyma. Tissues were fixed in formalin for subsequent microscopic examination, and representative images from the aortic valve, and from the cerebral cortex, are seen below.

What is the cause of death in this case?

Figure 1A: Aortic valve vegetation showing hyaline, septate branching hyphae of uniform diameter and with angular branching approximately 45 degrees. Background tissue shows a prominent neutrophilic exudate and necrosis (hematoxylin-eosin, original magnification 40x).

92 J La State Med Soc VOL 166 March/April 2014

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