An autopsy case of
rhabdomyolysis following homicidal intoxication of
paraphenylenediamine was reported and the toxicological mechanism of
PPD against skeletal muscles was discussed. The case was a 44 years old, previously healthy male, drinking a beverage containing
PPD, prepared for a homicidal use. Total intake of
PPD was about 3 g (63 mg/kg). Principal clinical manifestation of the patient was muscle rigor with tenderness, initially developed in the lower extremities and subsequently extending to all over the skeletal muscles. Laboratory examinations disclosed high CPK (137,600), LDH (3895), GOT (3400) and GPT (545), and
leukocytosis (26600), indicating massive skeletal muscle
necrosis. ECG revealed mild depression of ST junction in the II and aVF leads. Urine showed dark brownish discoloration and diminished in volume subsequently. Scattered
necrosis of muscular fibers was observed in a biopsy of the femoral muscles. The consciousness was rather clear during the course. The patient collapsed suddenly and soon died in the course of about 30 hours. Clinically, the cause of death was thought to be
acute renal failure due to
rhabdomyolysis. Afterwards
PPD was detected in the urine obtained in the hospital. Autopsy confirmed the clinical diagnosis: Renal collecting ductules and distal tubules were occluded by dark brownish
myoglobin casts and its epithelium massively necrotized; Skeletal muscles showed scatteredly coagulation
necrosis and were partially associated with inflammatory cell infiltration.