Forensic Science, Medicine and Pathology

, Volume 14, Issue 2, pp 229–235 | Cite as

Lethal endomyocarditis caused by chronic “Krokodil” intoxication

  • Antonella Sorrentino
  • Silvia Trotta
  • Anna Pia Colucci
  • Lucia Aventaggiato
  • Andrea Marzullo
  • Biagio Solarino
Case Report


“Krokodil” is a home-made opioid drug obtained by synthesizing desomorphine from codeine and combining it with other low-cost additives. Initially introduced in the former Soviet countries, it was then imported to Western Europe as a heroin substitute. To our knowledge, this is the first report of an Italian case of lethal krokodil abuse, that occurred in a 39-year-old man, who died suddenly after transportation to the Emergency Department (ED) for hyperthermia associated with sweating, dyspnoea and tachycardia. Post-mortem examination revealed extensive necrotic ulcerative lesions on the forearms, and autopsy showed a hypertrophic heart with ample endocardial vegetation on the aortic valve and patency of the foramen ovale. Histopathological examination of the heart showed ulcero-vegetative lesions of the aortic valve with an abscess on the annulus and extension to the periaortic adipose tissue, as well as diffuse myocardial interstitial inflammatory neutrophilic infiltrates. Toxicological analysis demonstrated a desomorphine metabolite in urine. On the basis of all these findings the cause of death was ruled to be congestive heart failure caused by endocarditis and myocarditis, correlated with chronic abuse of krokodil.


Krokodil Desomorphine Aortic valve endocarditis Myocarditis 


Compliance with ethical standards

Conflict of interest

None of the authors have conflicts of interest.

Human and animal studies and informed consent

The article does not contain any studies with human participants requesting their informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Antonella Sorrentino
    • 1
  • Silvia Trotta
    • 1
  • Anna Pia Colucci
    • 1
  • Lucia Aventaggiato
    • 1
  • Andrea Marzullo
    • 2
  • Biagio Solarino
    • 1
  1. 1.Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari HospitalUniversity of BariBariItaly
  2. 2.Department of Emergency and Organ Transplantation, Division of Pathology, Medical School, Policlinico di Bari HospitalUniversity of BariBariItaly

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