Methamphetamine-induced profound rhabdomyolysis and myoglobin cast nephropathy: A case report and a literature review
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Issued Date
2023-05-01
Resource Type
ISSN
1752928X
eISSN
18787487
Scopus ID
2-s2.0-85153512676
Journal Title
Journal of Forensic and Legal Medicine
Volume
96
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Forensic and Legal Medicine Vol.96 (2023)
Suggested Citation
Chansaengpetch N., Worasuwannarak W., Worawichawong S. Methamphetamine-induced profound rhabdomyolysis and myoglobin cast nephropathy: A case report and a literature review. Journal of Forensic and Legal Medicine Vol.96 (2023). doi:10.1016/j.jflm.2023.102530 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/81413
Title
Methamphetamine-induced profound rhabdomyolysis and myoglobin cast nephropathy: A case report and a literature review
Author's Affiliation
Other Contributor(s)
Abstract
A 46-year-old male with a history of substance abuse was found dead in custody 30 hours post incarceration for a minor offense. The scene demonstrates the body lying in a prone position in the cell room, locked from the outside. No signs of violence were found at the scene. External examination revealed no significant injuries, except for multiple minor contusions and abrasions. The autopsy demonstrated only a moderate degree of bilateral pulmonary edema. No internal injuries were found, except for fractures in the three lower left ribs. Dark reddish-brown urine was detected in the urinary bladder. Histological examination revealed a diffuse tubular injury with intraluminal eosinophilic granular casts. The myoglobin cast demonstrated pale PAS staining with a granular appearance, Masson Trichrome staining demonstrated fuschinophilic deposits on the casts, and immunoperoxidase staining for myoglobin was strongly positive in the casts (the images will be displayed). Blood myoglobin and creatine kinase levels were elevated. These findings revealed profound rhabdomyolysis caused by several factors. Blood toxicology tests revealed lethal methamphetamine and amphetamine levels. All the findings were consistent with methamphetamine-induced severe rhabdomyolysis. Therefore, forensic pathologists should carefully search for gross and histological findings and conduct thorough laboratory investigations to diagnose this condition for complete medicolegal examination.