A 62-year-old man is found dead in his apartment. An autopsy shows diffuse cerebral edema, laryngeal edema, and hyperinflated lungs. Which of the following is the most likely cause of death in this patient?

Question

A 62-year-old man is found dead in his apartment.  An autopsy shows diffuse cerebral edema, laryngeal edema, and hyperinflated lungs.  Which of the following is the most likely cause of death in this patient?

Quizplus · Accepted Answer

This patient with diffuse cerebral edema, laryngeal edema, and hyperinflated lungs most likely died from anaphylaxis. Anaphylaxis classically involves a type 1 (immediate) hypersensitivity reaction to an antigen that leads to IgE-mediated mast cell and basophil degranulation. The resulting sudden and massive release of inflammatory mediators (eg, histamine, leukotrienes) into the circulation can quickly lead to airway obstruction (eg, bronchospasm, oropharyngeal edema) and distributive shock (ie, profound peripheral vasodilation). Although some patients (eg, those who experience rapid cardiovascular collapse) have no significant gross autopsy findings, the most common abnormal findings resulting from anaphylaxis include the following: Cutaneous abnormalities (eg, urticaria, flushing) may also be present because anaphylaxis often involves the skin. To help confirm the diagnosis, patient serum can be sent for tryptase level analysis. Tryptase, a mediator released from mast cells, is elevated in many cases of anaphylaxis. (Choice A) In most cases of sudden death due to acute myocardial infarction (MI), death is due to an arrhythmia resulting from acute coronary occlusion, and an occlusive thrombus is often present on autopsy. Although cerebral edema could be present from hypoxia, an acute MI would not be expected to cause laryngeal edema and hyperinflated lungs. (Choice C) Patients with sudden death from chronic obstructive pulmonary disease (COPD) exacerbation could have hyperinflation of the lungs due to airway obstruction, as well as cerebral edema due to hypoxia. However, because COPD is a disease of the lower airway, it would not be expected to cause upper airway (eg, laryngeal) edema. (Choice D) Meningococcal meningitis can cause cerebral edema, as found on autopsy, but also commonly causes a purulent exudate in the meninges. It would not be expected to cause laryngeal edema or lung hyperinflation. (Choice E) Sudden unexpected death in epilepsy is not well understood but is believed to be caused by central apnea or cardiac arrythmias. It is the most common seizure-related cause of death and is frequently associated with cerebral edema, which is demonstrated on autopsy. However, laryngeal edema and lung hyperinflation are not expected. In addition, tongue lacerations and cutaneous abrasions are frequently present. Educational objective: Anaphylaxis (type 1 hypersensitivity) can quickly lead to respiratory compromise (eg, bronchospasm, oropharyngeal edema) and distributive shock. The most common autopsy findings include upper airway edema, hyperinflation of the lungs from airway obstruction, and cerebral edema from hypoxia. __________ References: Postmortem findings after fatal anaphylactic reactions. (http://www.ncbi.nlm.nih.gov/pubmed/10823122)

A 62-Year-Old Man Is Found Dead in His Apartment