Chapter 1 - The hermit and the street character: unusual diagnoses in forensic pathology

Abstract

Two natural and unusual causes of death are depicted in this chapter, both regarding adult women living in peculiar social settings. In the forensic pathologist’s routine natural deaths can, sometimes, be more difficult to determine, and explain, than violent deaths, such as homicides, suicides and accidents. The first deceased was a 39 years old woman living alone in an old and isolated country house, whose death was determined at autopsy as a fulminant septic shock by a pelvic inflammatory disease (PID) connected to the intrauterine presence of a contraceptive device (IUD). In the second case, the cause of death of the 44 years old homeless and mentally disabled woman was revealed by histopathological findings, which not only contradicted the diagnosis on admission to the infective diseases ward of the city hospital, but were also inconsistent with both the diagnosis of the cause of death delivered by the treating clinicians and the report of the clinical pathologist appointed to perform the autopsy. The second case was further complicated by the request of the prosecutor to evaluate the possibility of medical malpractice on the part of the hospital’s treating staff.