Forensic Pathology for Police - Brainshare Public Online Library

Multisystem and Other Disorders 251
with its own degree of severity. Clinically, patients with CF have abnormally viscous
(thick) secretions. The lungs, pancreas, small intestines, and salivary glands
can become obstructed, damaged, and infected, leading to death. Sweat glands are
also affected, leading to the commonly-employed “sweat chloride test” (in living
patients).
Ehlers–Danlos Syndrome: Ehlers–Danlos syndrome is a group of genetic disorders,
each with an abnormality in genes responsible for normal collagen formation.
The most serious type is type IV, in which arteries and organs (intestines, spleen,
uterus) are at risk for rupture. These patients may or may not have a history of
easy bruising. They may or may not have hyperflexible skin and hypermobile joints
(double-jointed).
Marfan Syndrome: Marfan syndrome is a genetic disorder characterized by
abnormalities in the gene for a connective tissue substance called fibrillin-1.
Clinically, patients tend to be very tall and lanky, with long fingers. Abnormalities
of the skeleton, eyes, and cardiovascular system are common. Most significant in
terms of death investigations are a predisposition to thoracic aortic dissections and
mitral valve prolapse.
Sarcoidosis
Sarcoidosis is a disorder characterized by the presence of multiple “granulomas”
(inflammatory nodules containing lymphocytes and macrophages). The cause of the
disease is unknown. No micro-organism or foreign substance can be identified in the
granulomas. The disease can affect anyone, but women and those of African descent
are at greatest risk. The granulomas can become quite large, and tend to involve the
lymph nodes, particularly those within the mediastinum (central thorax area), where
the enlarged nodes are sometimes referred to as “potato nodes” (Disc Image 10.54).
The lungs are also frequently involved, sometimes quite extensively. Death can be
related to severe respiratory compromise, but more frequently is related to the fact
that the heart can also be involved. Virtually any other organ can also be involved
with the disease.
Psychiatric Disease
A variety of psychiatric conditions may be associated with sudden, unexpected
death, including various eating disorders (see Chapter 21), and numerous disorders
characterized by psychotic behavior, such as schizophrenia or manic-depression.
Some persons are at risk for various non-natural events, such as suicide or adverse
drug reactions. Some individuals may experience excited delirium followed by sudden
death. The excited delirium is essentially identical to that seen in drug-induced
excited delirium, such as occurs with cocaine (refer to Chapter 11). A ruling on such
a case might read as follows: “excited delirium due to schizophrenia.” Occasionally,
the condition is referred to as “acute exhaustive mania.”