Publications

Authors:

Tatriele, Naomi; Giorato, Gloria; Baldisser, Francesco; Turrini, Rachele; Brunelli, Matteo; Ausania, Francesco; Pigaiani, Nicola

Title:

A Rare Case of Small Vessel Vasculitis in Fatal Promazine Intoxication: The Synergy of Adverse Events Resulting in Death

Year:

2025

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Format:

Elettronico

Referee:

No

Name of journal:

FORENSIC SCIENCES

ISSN of journal:

2673-6756

N° Volume:

5

Number or Folder:

1

Page numbers:

1-7

Keyword:

drug-induced vasculitis; forensic pathology; poisoning death; promazine hydrochloride; suicide

Short description of contents:

Background: Nowadays, exotoxic substance intake is among the most frequently employed methods of suicide. Self-poisoning is quite common among psychiatric patients treated in hospitals. Psychotropic drugs used for suicide include phenothiazines. Promazine hydrochloride (Talofen (c)) is an alpha-lytic phenothiazine neuroleptic with a high affinity for histaminergic H1 receptors and a low affinity for dopaminergic D2, serotoninergic 5-HT, alpha1-adrenergic, and muscarinic receptors, which may explain its potent sedative effect. The most common adverse effects include extrapyramidal syndromes, weight gain, orthostatic hypotension, QTc prolongation, convulsions, delirium, and psychosis. Rare adverse events include the potential occurrence of autoimmune syndromes and vasculitis. Methods: We report herein the delayed death of a 59-year-old woman due to cardiocirculatory arrest on an arrhythmic basis in the context of vasculitis of the small pulmonary vessels and prolongation of the QTc interval secondary to voluntary acute intoxication with promazine hydrochloride. Results: The incident occurred in a psychiatric patient with a history of prior self-harming acts. Histological investigations revealed wavy fibers in the heart, a lymphocytic granulocyte infiltrate in the walls of small- and medium-caliber vessels, and spotty perivascular deposition of histiocyte-macrophage cells in the lungs. Immunophenotypic investigations showed the prevalence of CD15+ and T-CD3+ elements, thus identifying a small vessel vasculitis. These findings were consistent with the literature regarding adverse events following the intake of promazine hydrochloride, although vasculitis is rare. Conclusions: Thus, while QTc lengthening and arrhythmic incidents are widely reported events associated with promazine hydrochloride use, the development of a rare condition such as pulmonary vasculitis undoubtedly played a synergistic and decisive stressogenic role in the genesis of the cardiac event, leading to irreversible functional arrest.

Product ID:

146010

Handle IRIS:

11562/1163098

Last Modified:

May 29, 2025

Bibliographic citation:

Tatriele, Naomi; Giorato, Gloria; Baldisser, Francesco; Turrini, Rachele; Brunelli, Matteo; Ausania, Francesco; Pigaiani, Nicola, A Rare Case of Small Vessel Vasculitis in Fatal Promazine Intoxication: The Synergy of Adverse Events Resulting in Death «FORENSIC SCIENCES» , vol. 5 , n. 1 , 2025 , pp. 1-7

Consulta la scheda completa presente nel repository istituzionale della Ricerca di Ateneo