Methanol poisoning in Klang Valley, Malaysia: Autopsy case series

Abstract

IntroductionDespite its rarity and sporadic occurrence, methanol poisoning may result in devastating consequences to the victims including death. MethodWe report a series of methanol poisoning cases following an outbreak in Klang Valley, Malaysia. Victims were presented as either brought-in-dead or died during hospitalization. Medico-legal autopsy was performed at the Department of Forensic Medicine, Hospital Sungai Buloh in all cases. We sought to establish epidemiology, survival period, level of methanol, autopsy, and neuropathology findings of the cases. ResultsSixteen deaths from methanol poisoning were retrospectively reviewed during a two-month period from September to October 2018. Majority of cases (81 %) were pronounced dead in hospital. Male victims predominated and more than 90 % were young productive adults. Ninety percent of the victims were immigrants. Intoxication symptoms developed within hours of ingestion and almost half of fatalities occurred within 3 days. Significant levels of methanol were detected from blood and other bodily fluids. Autopsy findings of early deaths were minimal and non-specific while delayed death cases within seven days to two weeks showed several morphological changes in the brain. Almost all cellular constituents of the nervous system were affected. Neuronal degeneration predominated in all lobes while axonal dystrophy was less commonly detected within the temporal region. ConclusionMany methanol poisoning victims became symptomatic within 24 h of ingestion. The severity of neuropathological changes correlated well with the period of survival which warrants in-depth studies particularly within areas of brain cellular response towards different levels of methanol toxicity.