International Journal of Legal Medicine

, Volume 130, Issue 1, pp 179–183 | Cite as

Multidrug-related leukocytoclastic vasculitis raising suspicion of sexual homicide—things are not always what they seem

  • Lucia TattoliEmail author
  • Klaus Krocker
  • Julia Sautter
  • Michael Tsokos
Case Report


Ambiguous findings during external examination of a deceased in combination with dubious autopsy findings can raise doubts concerning the manner and cause of death. We report the case of a 35-year-old female deceased who had suffered from a borderline personality and depressive disorder with suicidal ideation. At the death scene, the body showed massive facial swelling accompanied by complete reddening of the skin of the face, with patchy skin abrasions on the forehead and neck, and purple bruise-like discolorations distributed symmetrically over both shoulders, elbows, hands, hips, knees, lower legs, and feet, raising the suspicion of underlying massive external blunt force injury. Police investigators strongly suspected sexual homicide. At autopsy, dissection in layers revealed massive subcutaneous hemorrhages as the cause of the reddish skin discolorations. Toxicological analyses showed fatal levels of lamotrigine with additional proof of zopiclone, zolpidem, diphenhydramine, O-desmethylvenlafaxine, pregabalin, tramadol, and modafinil in venous blood. Histologically, both the macroscopically impressive purple skin changes with underlying bleeding into the subcutaneous tissue and the skin abrasions were due to leukocytoclastic vasculitis, a form of acute hypersensitivity vasculitis that was a reaction to the multiple therapeutic drugs that the woman had taken shortly before death. The manner of death was classified as suicide, and sexual homicide was ruled out.


Lamotrigine Leukocytoclastic vasculitis Blunt force injury Bruising Polytoxicomania Sexual homicide 


Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Lucia Tattoli
    • 1
    Email author
  • Klaus Krocker
    • 2
  • Julia Sautter
    • 2
  • Michael Tsokos
    • 3
  1. 1.Department of Public Health and Pediatrics, Section of Legal MedicineUniversity of TurinTorinoItaly
  2. 2.State Institute of Forensic Medicine and PathologyBerlinGermany
  3. 3.Institute of Legal Medicine and Forensic SciencesCharité – Universitätsmedizin BerlinBerlinGermany

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