Alleged Homicidal Choking in a Woman Recovering From Guillain-Barré Syndrome.

Abstract

Few reported cases of homicidal choking in medical literature involve aged, infants, and debilitated. Whenever an allegation is made, the forensic expert is expected to provide a balanced opinion based on scientific evidence. We report a sudden death of a woman recovering from Guillain-Barré syndrome (GBS), with an allegation of homicidal choking. A 53-year-old female was diagnosed of having Guillain-Barré syndrome and was managed in the hospital. She was slowly recovering and liquid meals were replaced by solids and she was mobilized. A relation was feeding her when she developed a sudden cardiac arrest. Her sisters alleged intentional choking. At autopsy, there were a few seeds of rice in her trachea at the bifurcation and in the right bronchus. Stomach contained few seeds of rice mixed with mucous. The contents of the trachea were tested for pH and were acidic. Microscopy revealed widespread viral myocarditis. Myocarditis is reported to coexist with GBS rarely and can lead to a sudden cardiac arrest. Few seeds of rice in the trachea cannot cause death from choking. Further, the acidic pH of the contents indicated gastric origin and therefore possible agonal aspiration or postmortem regurgitation.