Planned Complex Occupation-related Suicide by Sulfuric Acid Ingestion and Thorax Stab Wound: Case Report

Abstract

Sulfuric acid is a colourless, odorless liquid, which causes typical injury patterns such as cutaneous and ocular burns, respiratory complications from inhalation, and ingestion injuries (coagulative necrosis of the mucosa, gastric and intestinal perforations) with significant dermal and mucosal injury because of its corrosive action. Most injuries caused by sulfuric acid ingestion are accidental, especially in the paediatric population. Intentional cases of ingestion have rarely been reported in adults as a method of suicide following a major depressive disorder. In this paper, we report the case of a 44-year-old woman who was found dead outside her home with a retained fillet knife embedded in her left chest wall and cutaneous chemical burns extending from her mouth down her chin and anterior torso. During the crime scene investigation, a half empty bottle of chemical drain cleaner containing concentrated sulfuric acid was found next to her body. An autopsy revealed chemical burns to the tongue, trachea, larynx, pharynx and oesophagus along with a blackish fluid in the peritoneal cavity. Histological analyses showed extensive corrosive changes in the gastrointestinal tract. Toxicological screening of blood and urine samples was negative; gastric contents contained a high quantity of concentrated (≈ 96%) sulfuric acid with a pH value of < 1.0. Death was attributed to shock following sulfuric acid ingestion. Circumstantial evidence and autopsy findings proved that the manner of death was suicidal. Complex suicides can be challenging for the forensic pathologist because of the plurality of methods used. The authors highlight the importance of systematical exhaustive postmortem investigation in order to ascertain the cause and manner of death in cases of planned complex suicide.