Autopsy Cases Research Articles

Kasabach–Merritt syndrome, not only a pediatric condition: An autopsy case report and review of literature

Kasabach–Merritt syndrome (KMS), also known as hemangioma with thrombocytopenia, is a rare vascular disease characterized by thrombocytopenia, anemia, disseminated intravascular coagulation (DIC), and vascular lesions. It often occurs during infancy and the neonatal period and rarely in adults. The syndrome presents with consumptive coagulopathy initiated within a vascular tumor, mainly tufted angiomas or Kaposiform hemangioendotheliomas, and less commonly, hepatic and/or biliary hemangiomas. We report a case of a 41-year-old female with a recent diagnosis of biopsy proven biliary-type hemangioma of the liver, undergoing fertility treatment, who developed consumptive coagulopathy and disseminated intravascular coagulation shortly following a liver biopsy procedure, and ultimately demised. Based on the review of the literature, we present the first adult case of KMS where the diagnosis was made post-mortem. Given the rarity of this condition, particularly in the adult population, we believe our case adds value to the field of critical care medicine, coagulopathies, and forensic medicine.

Escherichia coli in medicolegal autopsy causing symmetrical peripheral gangrene and psoas abscess

Postmortem microbiology (PMM) plays a crucial role in identifying infectious causes of death, which have significant legal and clinical implications. Not only determining the cause of death, PMM is vital in identifying infectious pathogens providing valuable medical insights. This case series presents two medicolegal autopsy cases where Escherichia coli infections led to rare and severe complications: Symmetrical peripheral gangrene (SPG) and psoas abscess. The first case involves a 28-year-old female hospitalized for 35 days after allegedly consuming sedatives. Postmortem findings included gangrene in her hands and feet and extensive lung consolidation with pus nodules. Blood cultures identified E. coli, while lung swabs revealed Klebsiella pneumoniae and Candida spp. The second case involves a 32-year-old female experiencing abdominal pain and breathing difficulties who died en route to the hospital. The autopsy revealed congested lungs and a psoas abscess, with blood cultures confirming E. coli infection. E. coli, typically associated with urinary tract infections, can cause severe complications such as SPG and psoas abscess. SPG involves ischemic damage to extremities without central vessel occlusion, often linked to septicemia and disseminated intravascular coagulation. Psoas abscesses result from hematogenous spread or direct extension from adjacent structures. These cases highlight the need to consider atypical pathogen presentations in critically ill patients. Recognizing E. coli’s potential for rare, fatal complications emphasizes the importance of thorough microbiological analysis during autopsies to improve diagnostic accuracy, guide clinical management, and inform public health strategies. Integrating PMM into routine autopsy protocol is essential for advancing medical and forensic knowledge.

Comprehensive study of various vitamin concentrations in the human postmortem blood with an autopsy case report of beriberi.

Using human cardiac blood from forensic autopsy cases, comprehensive measurements of albumin, vitamins A, B1, B6, B12, C, D, folate, and PIVKA-Ⅱ were performed. Of 128 cases, 83 were male, with an average age of 61.8years and average postmortem interval of 44h. The average concentrations of vitamins were 29.8μg/dL for vitamin A, 32.2μg/dL for vitamin B1, 278ng/mL for vitamin B6 (pyridoxamine), 152ng/mL for vitamin B6 (pyridoxal), 57.2ng/mL for vitamin B6 (pyridoxal), 17.9ng/mL for folate, 1188pg/mL for vitamin B12, 23.5μg/mL for vitamin C, 15.0ng/mL for vitamin D, and 1.03μg/mL for PIVKA-Ⅱ. An autopsy case of a Japanese middle-aged male with beriberi was also presented, where severe edema and effusion of the cavity and a high NT-proBNP serum value were observed; however, cardiac pathology showed no specific abnormal features. In the present case, the blood vitamin B1 concentration was within the standard clinical range. This study revealed that bloodborne water-soluble vitamin levels shows higher to clinical standard value at postmortem, whereas fat-soluble vitamin levels may stay in the standard range or lower. Our findings suggest that postmortem water-soluble vitamin concentrations within the clinical standard may reflect low antemortem vitamin concentrations.

Tumor-to-tumor metastases: systematic review and meta-analysis of 685 reported cases.

Tumor-to-tumor metastasis is an exceedingly rare phenomenon where secondary deposits of a tumor develops in another one. Our systematic review and meta-analysis aims to uncover and analyze reported cases to enhance our understanding and improve patients' care. A comprehensive search of the literature was conducted to identify 685 cases of tumor-to-tumor metastasis from 543 articles. Key information, including the donor and recipient organs, tumor histology, primary to metastasis time interval, presence of distant metastases and overall survival was extracted and analyzed. The highest incidence of tumor-to-tumor metastasis was observed in breast cancer and lung cancer metastasizing to meningioma (n = 52, 7.6%; n = 49, 6.2%; respectively). There were 131 (19.2%) autopsy cases, 477 (69.6%) cases diagnosed in vivo, and in 77 cases (11.2%), the timing of diagnosis was unavailable. Death of the patient (including autopsy cases) was reported in 256 (37.4%) cases. In 160 (23.35%) patients, the primary of the metastasis (POM) was occult at the time of metastasis, and in 385 (56.2%) cases, the POM was already known. The median period between clinically overt primary cancer diagnosis and tumor-to-tumor metastasis was 2.0years. Donor metastases to other sites were observed in 328 (47.9%) cases. In multivariate Cox regression analysis, the primary-to-metastasis interval (< 3 vs > 3years, HR 2.01, 95% CI 1.18-3.43, p = 0.01) and the presence of donor metastases to other sites (present vs absent; HR 0.37, 95% CI 0.23-0.59, p < 0.001) were significantly associated with survival. In summary, our findings emphasize the necessity for heightened clinical vigilance, early detection, and tailored management to effectively address this unique and challenging clinical scenario.

Technical Note: Application of Luminol and Leucomalachite Green Tests to Wischnewsky Spots After Formalin Fixation.

Wischnewsky spots are disseminated, dark lesions in gastric mucosa reflecting hemorrhage associated with fatal hypothermia, and are a phenomenon well known to forensic pathologists. We applied luminol and leucomalachite green tests to formalin-fixed gastric mucosa with Wischnewsky spots in autopsy cases of hypothermia. Both luminol and leucomalachite green tests showed positive reactions. We describe the technical significance of these tests in forensic diagnosis, in that luminol and leucomalachite green tests may be useful in forensic autopsy cases, and may also be useful for formalin-fixed organs.

Mummification – a forensic case series

ABSTRACT Mummification refers to a process of desiccation with loss of up to 60–70% of the body weight. It may be unintentional when a body is exposed to dry heat, extreme cold or to reduced amounts of air, or it may be intentional from embalming or drying. To evaluate mummification in a contemporary medicolegal situation selected Pathology Files at Forensic Science SA (FSSA), Adelaide, Australia, were searched from 2004 to 2023 for autopsy cases where bodies had been described as completely mummified. Twenty-one cases were identified (out of a total of 2872 cases - <1%) consisting of 17 males and 4 females (M:F = 4:1) with an age range of 27 to 95 years (average 62 years). The estimated post mortem intervals ranged from 2 to 16 weeks (average 5 weeks) with 16 cases (76%) occurring during the warmer months. Nineteen bodies (91%) were found inside home addresses Causes of death were determined in only seven cases (33%) (3 drug toxicity; 3 cardiovascular disease and 1 hypothermia). Thus, the most typical case involved a socially isolated older male during summer at his home address. Changes to the body after mummification, with distortion and loss of tissues and organs, present challenges to forensic practitioners who may have difficulties in determining the time, cause and manner of death.

Bilateral Renal Fungal Bezoars and Perinephric Abscess in an Infant With Arthrogryposis-Renal Dysfunction-Cholestasis Syndrome: A Clinico-pathologic Case Report.

The patients with Arthrogryposis-Renal dysfunction-Cholestasis (ARC) syndrome have genetic susceptibility to the opportunistic infections due to the involvement of VPS33B (vacuolar protein sorting 33 homolog B) in phagolysosome fusion in macrophages. Detailed pathologic studies in ARC patients are missing in literature due to the lack of autopsy. We described the first autopsy case of ARC syndrome in a 2-month-old male infant. His death was due to recurrent sepsis and multiorgan failure despite the appropriate poly-antibiotic therapy and supportive care. The autopsy showed invasive renal candidiasis including bilateral destructive pyelonephritis, pelvic obstructive fungal bezoars, and right large perinephric abscess. The main other findings included severe chronic liver changes and pneumonia. Liver exhibited intrahepatocyte cholestasis, large multinucleated hepatocytes, diffuse portal, bridging and perivenular fibrosis, and interlobular bile duct proliferation. The neuropathologic examination was unremarkable. This case report highlights 3 novel findings. The ARC syndrome-related immunodeficiency may predispose to renal fungal bezoars and perinephric abscess. Cholestatic stress may result in the proliferation of interlobular ducts as an adaptive response. Absence of spinal motor neuron degeneration suggests that the neurogenic amyotrophy is due to the lack of synaptic vesicle trafficking and membrane fusion rather than the defect in cell survival-related autophagosome-lysosome fusion.

Cocaine and aortic dissection: the need for collaboration to overcome the underreporting bias.

The dissection of the aorta is a serious and potentially fatal consequence of cocaine use. Nonetheless, the underlying mechanisms and characteristics of this phenomenon remain to be deeply studied. The autopsy case of a 46-year-old white male found irresponsive and unconscious in his house and had a history of abusing cocaine is presented. Autopsy findings showed aortic arch and thoracic aorta of regular calibre, with evidence of a mid-adventitial dissecting aneurysm of the ascending intrapericardial portion of the aorta. Forensic toxicological analyses evidenced a positivity to cocaine and its main metabolite, benzoylecgonine, in all fluids (peripheral blood, bile and urine), liver and brain homogenates. Data also evidenced a positivity to alcohol, confirming a past history of intake. The presented case confirms the connection between cocaine addiction and the risk of aortic dissection, emphasizing the need for increased knowledge about the risks connected to this drug. It is emphasized the need of prompt examination and effective treatment of patients exhibiting cardiac symptoms linked to cocaine use, as well as the need of an accurate anamnesis to evidence use/abuse of other cardiotoxic substances.

Comparison of background characteristics and neuropathology findings between medico-legal autopsy cases with traumatic axonal injury, vascular axonal injury, or absence of axonal injury in β-amyloid precursor protein stain.

In forensic neuropathology, the β-amyloid precursor protein (β-APP) immunostain is used to diagnose axonal injury (AI). The two most common aetiologies are traumatic (TAI) and ischaemic (vascular; VAI). We aimed to identify background characteristics and neuropathology findings that are suggestive of TAI, VAI, or no AI in neuropathologically examined medico-legal autopsy cases. The dataset comprised 166 cases from Finland over the period 2016-2023. The diagnosis of AI was based on β-APP stain (TAI, VAI, or no AI). Data on background characteristics and neuropathology findings were collected from cause-of-death investigation documents. Prevalence ratios were calculated for each variable to enable comparisons between the AI categories. The sample were 71.7% males; median age was 41 years (range 0-96). There were 26 cases with TAI, 44 with VAI, and 96 with no AI. The variables that showed statistical significance and had at least two-fold prevalence among TAI cases compared to VAI cases were: a documented recent injury; and presence of any extracranial/cranial/intracranial injury (including subdural haemorrhage [SDH], subarachnoid haemorrhage [SAH], intracerebral/ventricular haemorrhage [ICVH], or contusion) in autopsy or neuropathology. Correspondingly, variables indicating TAI over no AI were: a documented recent injury; postinjury survival ≥ 24h; and presence of any extracranial/cranial/intracranial injury (including SDH, SAH, ICVH, contusion), herniation, or infarction in autopsy or neuropathology. Postinjury survival < 30min was identified as an indicator of no AI over TAI. Finally, variables indicating VAI over no AI were: postinjury survival ≥ 24h; lack of external injury to the head; and presence of SDH, brain oedema, herniation, or infarction in autopsy or neuropathology. In conclusion, we report several differences in characteristics and findings between cases diagnosed with TAI, VAI, and no AI. Our findings may help estimate the likelihood and potential aetiology of AI based on background characteristics and other neuropathology findings.

Motor involvement in frontotemporal lobar degeneration with TAR DNA-binding protein of 43 kDa type C.

The degeneration of pyramidal tracts has been reported in frontotemporal lobar degeneration with TDP-43 (TAR DNA-binding protein 43) pathology (FTLD-TDP) type C. Herein, we examined the detailed pathology of the primary motor area and pyramidal tracts in the central nervous system in four autopsy cases of FTLD-TDP type C, all of which were diagnosed by neuropathological, biochemical, and genomic analyses. Three patients showed right dominant atrophy of the frontal and temporal lobes, while the other patient showed left dominant atrophy. All four patients showed motor symptoms, and two patients had episodes of repeated aspiration. In the primary motor area, phosphorylated TDP-43 (p-TDP-43) or annexin A11-immunoreactive long dystrophic neurites were observed in all cases, and neuronophagia of the Betz cells was frequently observed in two of four cases. In the lower motor system, p-TDP-43 or annexin A11-positive dystrophic neurites were detected in the anterior horn of the spinal cord. Immuno-electron microscopy of the insoluble fraction extracted from all cases showed p-TDP-43 or annexin A11-labelled filaments. In FTLD-TDP type C, neurodegeneration with TDP and annexin A11 pathology was observed mainly in the upper motor neurons of both patients with right- and left predominant temporal atrophy and a short disease duration. Furthermore, a combination of TDP-43 and annexin A11 pathology was visible in the lower motor neurons, albeit less frequently. In summary, we reported the TDP-43 and annexin A11-associated involvement of anterior horn cells of the spinal cord for the first time. The degeneration of the motor system could contribute to dysphagia and aspiration pneumonia at the late stage of FTLD-TDP type C. Little or no TDP pathology was found in the corticospinal tract, unlike in FTLD-TDP type B, suggesting the occurrence of secondary degeneration in FTLD-TDP type C.

First year of in-house forensic neuropathology consultations in Helsinki, Finland.

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house.

Continuous increase in podocyte numbers in the first 36months of life-insights from forensic autopsies in Japanese children.

Podocyte depletion is a critical factor in glomerulosclerosis development. While podocyte numbers per glomerulus typically decline with age in adults, they are hypothesized to increase during childhood. However, studies on podocyte number progression in childhood have been limited. This retrospective analysis examined forensic autopsy cases of Japanese children without kidney disease, aged under 192months, between April 2010 and March 2023. Podocytes were identified using immunostaining with an anti-transducin-like enhancer of split 4 antibody and p57. Podometric parameters were estimated using the correction factor method, allowing estimation from a single histologic section. This study included 68 cases with a median age of 9months (interquartile range [IQR], 4-78). All podometric parameters correlated with age. Children younger than 36months displayed significantly fewer podocyte numbers per glomerulus (median, 517; IQR, 483-546) compared to those aged 36months and older (median, 616; IQR, 595-649; p < 0.001). Regression analysis revealed a significant age-related increase in podocyte numbers per glomerulus in children under 36months (slope, 3.76; p < 0.001; 95% confidence interval [CI], 2.34-5.19), but not in those aged 36months and older (slope, 0.25; p = 0.16; 95% CI, - 0.10-0.61). Additionally, the change in the slope at 36months was significant (p < 0.001; 95% CI, 1.02-2.49); however, this increase did not appear linked to podocyte division. Podocyte numbers per glomerulus increased from birth until 36months and then stabilized. These findings could facilitate the development of novel treatments for chronic kidney disease caused by glomerulosclerosis and contribute to pediatric kidney health research.

Asphyxia due to Blood Aspiration Caused by Maxillofacial Injury With Alcohol Consumption: A Forensic Autopsy Case Report and Feedback From a Forensic Medicine Perspective

ABSTRACTBackgroundAirway management and hemorrhage control are important with in treatment of oro‐nasal bleeding from maxillofacial injuries.Case PresentationWe report an autopsy case of an individual who was found dead in his home and died of asphyxia due to blood aspiration caused by maxillofacial injury. Evidence of crush injury of the nose, Le Fort I fracture, C7 spinal injuries, and blood aspiration in the airways was recorded. Alcohol was detected in the blood.ConclusionMaxillofacial injury can cause “blood to flow into the airways” and may be associated with “cervical spine injury”; these more often occur under the influence of alcohol.

Acute Liver Failure Caused by Isoniazid during Preventive Treatment for Latent Tuberculosis: A Rare Autopsy Case Report

Treating patients with latent tuberculosis infection (LTBI) to prevent the development of tuberculosis is a fundamental treatment strategy in daily practice. Isoniazid (INH) therapy for 6-12 months is recommended. However, INH can also cause hepatotoxicity. This report describes the autopsy case of a 65-year-old Japanese man diagnosed with LTBI who died of acute liver failure caused by INH.

Background characteristics and neuropathological findings of medico-legal autopsy cases with acute head injury and chronic alcohol use

Chronic alcohol use is often associated with traumatic brain injury (TBI). This study aimed to compare background characteristics, injury circumstances, primary head injuries, and secondary brain injuries among TBI cases with and without a documented history of chronic alcohol use. The sample comprised neuropathologically examined medico-legal autopsy cases with acute head injuries from Helsinki, Finland, over the years 2016-2022. Data on chronic excessive alcohol use were collected from medical records and police files; other background and circumstantial data were collected from medical records, police files, and cause-of-death investigation documents; and data on primary head injuries and secondary brain injuries were collected from autopsy and neuropathology reports. The dataset comprised 47 cases, of whom 19 had a history of chronic alcohol use (40.4%). Assault was the most common circumstance of injury among chronic alcohol users (47.4%) while falls prevailed among control cases (32.1%); unknown circumstances were common among both groups. There were no statistically significant differences in the prevalence of primary head injuries or postinjury survival between the groups. As for secondary brain injuries, hypoxic-ischaemic neuronal injury was significantly more common among chronic alcohol users in the frontal cortex (84.2% vs. 28.6%), parietal cortex (84.2% vs. 32.1%), hippocampus (63.2% vs. 25.0%), and lenticular nucleus (73.7% vs. 21.4%). Our findings suggest that chronic alcohol users may not necessarily have more diverse or complex primary injuries, but they may have more extensive secondary injuries. Further research should aim to explore the potential aetiology of hypoxic-ischaemic neuronal injury among chronic alcohol users.

Completed suicide risk factors among people living with HIV in Hunan Province identified through a psychological autopsy case–control study

Accumulating evidence has shown an increased risk of suicide among people living with HIV/AIDS (PLWHA). However, few studies have explored the risk factors associated with completed suicide among PLWHA. This study aimed to identify the characteristics and causes of completed suicide among PLWHA to guide future targeted suicide prevention and intervention programs. A 1:1 matched case–control psychological autopsy study was conducted among PLWHA in Hunan Province. We recruited 63 PLWHA who died by suicide from January 1, 2013, to December 31, 2019, and 63 living controls matched for age, gender, and employment. Two informants for each participant were interviewed to collect data on participants’ sociodemographic characteristics, depressive symptoms, HIV-related stress, hopelessness, and social support. The median survival time from HIV diagnosis to completed suicide was 3.9 months (IQR: 0.57–14.13). Most completed suicides occurred within six months of HIV diagnosis (71.4%), with poisoning (34.9%) and hanging (22.2%) as the primary methods. After controlling for confounding factors, we identified four risk factors of completed suicide: not receiving antiretroviral treatment (OR = 6.805; 95% CI: 1.227 to 37.738), receiving low-income subsidy (OR = 16.272; 95% CI: 3.245 to 81.598), HIV-related stress (OR = 1.332; 95% CI: 1.089 to 1.629), and hopelessness (OR = 2.910; 95% CI: 1.378 to 6.144). PLWHA are at a high risk of suicide within the first six months of HIV diagnosis, indicating an urgent need for immediate suicide screening and timely intervention. Suicide risk is affected by multiple factors, including sociodemographic, clinical, and psychological factors, indicating the need for a multifactorial approach to suicide prevention, which may involve early initiation of ART treatment and provision of economic and psychosocial support.

Clinical, Pathological, and Molecular Findings in a Mexican Patient With Neuronal Ceroid Lipofuscinosis Type 2: Support for Pathogenicity of the c.1226 G>T Variant and for Presence of Cherry-Red Spot in This Disease.

Neuronal ceroid lipofuscinosis type 2 (CLN2) results from biallelic pathogenic variants in the TPP1 gene, leading to deficient activity of the lysosomal enzyme tripeptidyl peptidase 1. We report an autopsy case of CLN2 characterized at molecular level. The patient exhibited a spectrum of neurologic symptoms including epilepsy, behavioral alterations, cognitive regression, motor impairment, and visual loss. In fundus exam, a cherry-red spot was observed. She died at 7 years old, autopsy demonstrated severe atrophy of the brain and cerebellum with neuronal loss and gliosis. Neurons were distended by autofluorescent ceroid lipofuscin of 2 types: fine granular deposits and coarse round bodies. In addition, electron microscopy study revealed characteristic curvilinear profiles. After autopsy, a germline molecular test was performed that found the c.1226 G>T variant in a homozygous state. This variant has been referenced in a single undetailed report and is classified as of uncertain significance. Our findings support that cherry-red spot can be present in CLN2 and confirm the pathogenicity of the c.1226 G>T variant. Current management of CLN2 includes enzyme replacement that requires early diagnosis, which can be facilitated by clinical delineation of the disease and appropriate classification and public reporting of TPP1 variants.

Yellow meconium.

The intestinal content of newborns is known as meconium, usually described as a black-greenish slimy substance. However, in rare cases, meconium might be yellow. This is of great relevance with regard to the forensic assessment of life birth, i.e. (longer) survival time and possible (breast-)feeding before death. While in older German forensic literature, yellow meconium has been occasionally mentioned from the 19th century on - without any conclusions being drawn from this finding whether the newborn was alive or had been fed -, current forensic literature does not provide information about this phenomenon. No reports of yellow meconium were found in (older) English forensic literature as well. We report two cases of newborn autopsies with yellow meconium and provide a short overview of the respective literature.

Human Identification in Mass Disasters: Analyzing Complex Tattoos in the Brumadinho Tragedy

Background: The identification of victims in mass disasters is a challenging task, particularly when forensic teams must address fragmented human remains. Objectives: This article reports two necropsy cases from the 2019 collapse of the Brumadinho mine tailing dam, the largest humanitarian disaster in Brazilian history. Results: In both cases, identification was achieved through comparative anthropological analysis of complex tattoos. Positive identification was based on the presence of multiple coincident points between postmortem (PM) and antemortem (AM) photographic records of the tattoo designs, along with the absence of exclusionary elements. Conclusion: The authors propose that the comparative analysis of PM and AM tattoos should be more widely adopted as a low-cost, rapid identification method, particularly in complex forensic scenarios such as mass disasters and other challenging cases in the medical and forensic anthropology context.

Potential postmortem microbial biomarkers of infant and younger children death investigation.

Microbial communities associated with the human body are highly dynamic and reflect the host environment and lifestyle over time. Studies show death is no exception, with data demonstrating similar antemortem and postmortem microbiomes up to 48 h following death. These predictable microbial biomarkers can inform death investigation by helping to estimate the postmortem interval and build models to identify cause and manner of death. However, no attempts have been made to model potential microbial biomarkers in pediatric (≤2 years) deaths. This study provided a cross-sectional survey of the microbiota of 53 pediatric cases (black, white, both sexes) seen in Wayne County, Michigan. Autopsy cases represented accidents, homicides, or natural causes. Postmortem microbiome were collected by swabbing the eyes, ears, nose, mouth, umbilicus, brain, rectum, trabecular space, and cardiac blood. 16S rRNA sequence analyses indicated that sex, race, age, body site, and manner of death (MOD) had significant effects on microbiome composition, with significant interactions among MOD, race, and age. Amplicon sequence variants identified intra- and interhost dispersion of the postmortem microbiome depending on death circumstance. Among manners of death, non-accidental deaths were significantly distinct from all other deaths, and among body sites the rectum was distinct in its microbial composition. There is a real need for robust postmortem microbiome before it can be standardized as a practical tool for use in forensic investigation or public health. These results inform postmortem microbial variability during pediatric death investigation that contributes to a larger effort to understand the postmortem microbiome.