Death from the introduction of Ceftriaxone in the presence of Lidocaine (case report)

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Abstract

In clinical and expert practice, pathological processes such as toxic reactions and anaphylaxis may develop following the introduction of the local anesthetic lidocaine; however, information about the death of children is limited and scattered. The morphological signs of these cases are non-specific, which leads to difficulty in interpreting the results of the study and determining the causes of death.

This report described the death of a child following intramuscular administration of ceftriaxone in a 2% lidocaine solution. The results of the primary and commission examination of the corpse and data of repeated pathohistological examinations of a 2-year-old child are presented. The objective expert conclusion about the cause of death following the intramuscular administration of ceftriaxone in a 2% lidocaine solution was toxic effects (overdose) or anaphylactic shock, which requires assessing the sequence of the event and nature of the clinical picture, taking into account the route of drug administration, comprehensive pathohistological and morphological studies, and mandatory forensic chemical determination of the concentration of these drugs in the internal organs and blood.

Morphological signs of an allergic reaction can be verified based on pathomorphological data, including changes in the target organs of anaphylaxis and pronounced hemocirculatory disorders. In our opinion, further in-depth study and systematization of available data are needed.

About the authors

Elena N. Travenko

Kuban State Medical University

Email: elenaschon@yandex.ru
ORCID iD: 0000-0001-7403-2521
SPIN-code: 8748-3506

MD, Dr. Sci. (Med.), Assistant Professor

Russian Federation, Krasnodar

Valeriy A. Porodenko

Kuban State Medical University

Email: porodenko52@mail.ru
ORCID iD: 0000-0001-6353-7380
SPIN-code: 6685-8824

MD, Dr. Sci. (Med.), Professor

Russian Federation, Krasnodar

Anastasia V. Surikova

Kuban State Medical University

Author for correspondence.
Email: avsurikova56@yandex.ru
ORCID iD: 0000-0003-4883-0815
Russian Federation, Krasnodar

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Supplementary files

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2. Fig. 1. Lymphoid infiltration with eosinophilic leukocytes in the tracheal wall. Coloring: hematoxylin and eosin, ×20.

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3. Fig. 2. Accumulation of eosinophilic leukocytes in the lumens of the vessels of the lungs. Coloring: hematoxylin and eosin, ×100.

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4. Fig. 3. Minor polymorphic cell infiltration and eosinophilic leukocytes in the bronchial wall. Coloring: hematoxylin and eosin, ×100.

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5. Fig. 4. Spasm of bronchioles. Coloring: hematoxylin and eosin, ×20.

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6. Fig. 5. The presence of homogeneous brown masses in the lumen of the bronchioles, with an admixture of cells of desquamated brochiolar epithelium. Coloring: hematoxylin and eosin, ×20.

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7. Fig. 6. Hemodynamic disturbances in the microvasculature system: mixing of formed elements from plasma, with an admixture of eosinophilic leukocytes. Coloring: hematoxylin and eosin, ×20.

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