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region, along with its correctly inserted electrodes from the heart electricity was excluded in cases of death by low voltage cur-
cavities. Postmortem review of the device did not display any sig- rent in an experimental study by Haedrich et al.17 Myocardial
nificant arrhythmia before death. The heart was enlarged and infarction, cancers, infection, and fever from a variety of causal
dilated, measuring 20 16 5 cm and weighing 915 g. The agents can produce pathological conditions before death that
myocardium was yellowish with fibrosis and carried numerous could result in elevated body core temperature at the time
subendocardial scars. Acute ischemia of the heart muscle was of death.2,18,19
not detected during macroscopic examination. The atherosclero- Another well-known condition associated with the elevation
sis of the coronary arteries was advanced. Autopsy of the other of mean core body temperature is excited delirium. Hyperthermia
internal organs revealed lung edema, chronic congestion in the is even considered a strong supportive evidence for the diagnosis
liver, and renal cysts. The cause of death was macroscopically of sudden death caused by excited delirium.20
assessed to be heart failure. Histological examination of the heart Generally, the spontaneous rise in body temperature after
showed acute congestion, interstitial fibrosis, hypertrophy and death is interpreted as a short-term surplus of heat production
atrophy of cardiomyocytes, nuclear variation, absence of necrosis from postmortem metabolic processes17 occurring alongside con-
of cardiomyocytes, and lack of inflammatory infiltrates. Microbi- tinuing tissue and bacterial metabolism10 and insufficient ther-
ological examination of the scrapings from the skin of lower limbs mal loss. In our case, the erysipelas of the lower limbs could be
revealed nothing unusual. The analysis of alcohol blood level and an acceptable explanation of elevated body temperature after
other toxicology examination were not requested because of the death; however, this was not demonstrated in the autopsy speci-
preceding 10-day hospitalization. mens. There were no other evident pathological or environmental
factors that could explain the abnormal rise in body temperature
after death.
DISCUSSION
A normal living body core temperature is generally 37.2°C,
with fluctuations between 36.7°C and 37.7°C.4,5 After death, a CONCLUSIONS
body core temperature of 37.2°C or higher after the temperature We have presented here a case of expected cardiac death in
plateau (a mean interval of 2 hours) indicates postmortem hyper- the hospital with precisely recorded postmortem hyperthermia.
thermia.3 Previous experimental studies recording rectal tempera- The phenomenon of postmortem hyperthermia is well known in
ture measurements in the early postmortem period were based on forensic practice, but it is still not entirely clear how frequently it
the bodies of recently deceased persons (with a known time of occurs and in which specific cases we may expect postmortem
death) and a constant ambient temperature.3,6–9 hyperthermia. However, rectal body core temperature after death
According to the medicolegal literature, postmortem hyper- is measured at the scene as an important forensic evidence, to be
thermia is not a unique phenomenon. Initial postmortem elevation collected rapidly before it begins equalizing with the environment's
of rectal temperature was reported in 1985 by Hutchins,10 and temperature. As a rule, the common course of body cooling is
Muggenthaler et al3 reported hyperthermia at the time of death in expected in routine forensic practice. As illustrated by our case,
18 of 84 cases in a study of postmortem rectal cooling. Demierre body temperature changes can be grossly unusual and unexpected
et al2 recorded elevated body core temperature in 10% of violent and may misinform forensic estimation of time since death in the
death cases in a representative study of 744 cases. early postmortem period.
Many possible causes of postmortem hyperthermia have been
discussed in the literature. Hyperthermia can result from patholog-
REFERENCES
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