Analysis of taxine B/isotaxine B in a plasma specimen by LC–MS/MS in a case of fatal poisoning: concealed suicide by ingestion of yew (Taxus L.) leaves of a patient with a long-term history of borderline personality disorder

Abstract

This case report deals with a 25-year-old woman who suffered from a long-term borderline personality disorder and from acute suicidal tendencies, including the intentional consumption of poisonous plants. When questioned during her self-referral to the psychiatric emergency department, she denied any suicide attempt or consumption of poisonous agents. Due to her medical history, her admission was followed by an intensive medical observation. During this observation period, the patient suffered an episode of acute respiratory insufficiency, which was followed by cardiac arrest. All resuscitation attempts were futile. Due to the unexplained nature of her death, the case was referred to the criminal investigation department. All findings of the routine systematic toxicological analysis of the patient’s blood sample, including immunochemical examinations and a high-performance liquid chromatography general unknown screening for drugs, were in accordance with the patient’s medication regimen and did not indicate a lethal overdose of any drug. During the analytical examinations, the deceased’s mother informed the psychiatric outpatient service of having found yew leaves in her daughter’s clothes and at her flat. The liquid chromatography--tandem mass spectrometry target analysis for yew pseudo-alkaloids (taxine B/isotaxine B) yielded a combined concentration of 110 µg/L. No autopsy was performed, because no criminality was suspected. In conclusion, it seems most plausible to conclude that the patient died of yew intoxication.