Forensic Science International 187 (2009) e19–e21

Short communication

Discolouration of the brain as the only remarkable autopsy findingin hydrogen sulphide poisoning

Seong Hwan Park, Yong Zhang, Juck-Joon Hwang *

Department of Legal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea

A R T I C L E I N F O

Article history:

Received 16 April 2008

Received in revised form 19 January 2009

Accepted 3 February 2009

Available online 17 March 2009

Keywords:

Hydrogen sulphide

Poisoning

Discolouration

Contents lists available at ScienceDirect

Forensic Science International

journa l homepage: www.e lsevier .com/ locate / forsc i in t

Hydrogen sulphide (H2S), an extremely noxious gas that smellslike rotten eggs [1], is generated from natural sources, industrialfactories, sewage systems and putrefying organic materials [2,3].Fatal H2S poisoning results in both nonspecific changes, such aspulmonary oedema and congestion [4,5], and greenish discoloura-tion of the internal organs, especially of the brain [6–8]. However,despite its reputation, this ‘classic’ discolouration is extremely rare[4], and the greenish discolouration of the internal organs haveonly been identified in three reports [6,7,9]. Here, the authorsreport a fatal case of H2S poisoning, where the only remarkableautopsy finding was greenish discolouration of the brain.

1. Case history

A 35-year-old Korean male was found unconscious in achemical manufacturing factory. According to the factory manager,the deceased was performing a pilot test for a new product. Beforehe was found unconscious, he added sodium hydrosulphide(NaSH) flakes to the reaction tank. This reaction used sulphuricacid (H2SO4) as a catalyst for the esterification of diethylene glycolmonomethyl ether, triethyl amine and 4-nitrobenzoil. On beingdiscovered unconscious, he was immediately sent to the emer-gency unit for cardiopulmonary resuscitation. Despite intensiveresuscitation, he died an hour later. To determine if H2S poisoningwas the cause of death, as suspected by the factory manager, the

* Corresponding author at: Department of Legal Medicine, College of Medicine,

Korea University, 126-1 Anamdong 5-ga, Seongbuk-gu, Seoul, Republic of Korea.

Tel.: +82 2 920 6158; fax: +82 2 928 3901.

E-mail address: kuforen@gmail.com (J.-J. Hwang).

0379-0738/$ – see front matter � 2009 Elsevier Ireland Ltd. All rights reserved.

doi:10.1016/j.forsciint.2009.02.002

police department requested an autopsy. The autopsy wasconducted 12 h after the death.

2. Pathology

The deceased was a 162-cm tall, muscular man. Generalisedpost-mortem rigidity was noted. Post-mortem lividity was formedon the back and was dark bluish-red in colour. Nail beds on theright fingers showed cyanosis. There were no external signs ofputrefaction, such as marbling, bloating, discolouration, foul odouror decomposition fluid. Internal examination of the trunk onlyrevealed pulmonary oedema and petechial haemorrhage of thetracheal mucosa. However, on opening the skull, it was revealedthat the brain had an unusual greenish discolouration (Fig. 1).Aside from the discolouration, the brain showed no otherpathological lesions and had no identifiable changes in consistencyand elasticity. The cut surface of the brain revealed that thegreenish discolouration was concentrated in the grey matter andnuclei, both of which are packed with neurons. A blood gas analysisrevealed that the sulphide ion (S2�) concentration was 1.1 ppm(parts per million), about 36-fold higher than the reference value(0.03 ppm1). In contrast, blood carboxyhaemoglobin (CO–Hb)concentration was less than 1%. Routine histopathologicalexamination revealed no remarkable pathological changes, exceptfor pulmonary oedema and congestion. The cause of death wasdetermined to be H2S poisoning.

3. Discussion

Sodium hydrosulphide is used in some industries. When itcomes in contact with an acidic material, H2S gas is produced

Fig. 1. In situ appearance (A) and cut surface (B) of the brain show a marked greenish discolouration of the grey matter and nuclei, which is not observed in the brain of an

ischaemic heart attack case (C and D).

S.H. Park et al. / Forensic Science International 187 (2009) e19–e21e20

[1,10–12]. In this case, it is possible that after the esterificationreaction, the residual H2SO4 might have reacted with H2S.Therefore, it is highly probable that both NaSH and H2SO4 playedthe main role in H2S production. The typical rotten egg odour ofH2S cannot be perceived above 150 ppm. Probably, if the reactionhad resulted in instantaneous, high concentrations of H2S gasabove 1000 ppm [8], the victim may have collapsed without awarning and with no chance to escape.

Although H2S poisoning is typified by a greenish discolourationof the internal organs [4–9], only three reports have identified this

Table 1Summary of three previous reports and the present case.

Larson et al. [6] Adelson and Sunshine [7

Discolouration 1. Brain, blue-green 1. Cerebral cortex and n

masses, greenish-purple

2. Skin, red-brown 2. Liver, greenish

3. Cyanosis, greyish-gree

Location Fertiliser factory (indoor) Sewer system (inside)

Possible source of gas Feather processing Influx from a lubricant f

Toxicology N/A N/A

Ambient concentration 200 ppm, at least N/A, maybe massive

Other autopsy findings Pulmonary oedema Pulmonary oedema

Number of victims 1 3

unusual condition (Table 1). The pathological mechanism for thisdiscolouration remains unknown. Although it is hypothesised thatthe denaturation of sulphur and haemoglobin may be responsiblefor the discolouration, acute H2S poisoning does not result in highlevels of sulphhaemoglobin before the onset of putrefactivechanges [7].

In this case, the factory manager’s suggestion of accidental H2Spoisoning eased the determination of the cause of death. However,in other cases where H2S poisoning is not immediately suspected,the pathologist might ignore the greenish discolourations and

] Campanya et al. [9] Present case

uclear Lung, liver and kidney,

blackish-green

Grey matter and nuclei,

dark greenish

n

Waste water tank (inside),

containing polysulphide

Chemical factory (indoor)

actory Reaction of polysulphide

and hydrochloric acid

Reaction of sodium hydrosulphide

and sulphuric acid

Over 3.5 mg l�1 (3.5 ppm),

sulphide

1.1 ppm, sulphide

N/A, maybe high N/A, maybe high

Meningeal congestion and

cerebral oedema

Pulmonary oedema and acral

cyanosis

2 1

S.H. Park et al. / Forensic Science International 187 (2009) e19–e21 e21

might not request for a blood gas analysis to determine sulphideion concentration. In such cases, when the greenish discolourationof the internal organs, especially the brain, is not correlated withthe freshness of the corpse, H2S poisoning should be suspected asthe cause of death.

Acknowledgements

The authors thank Dr. Kwang Hoon Kim and Dr. Gap Rae Cho,the former medical examiners in Southern District Office ofNational Institute of Scientific Investigation (NISI) for pathologicaladvices, and Dr. Jae Hoon Yu, Dr. Mi A Gwon and Dr. Hye Jin Choi inthe forensic chemistry branch of the NISI Southern District Officefor their support in blood gas analysis. The authors also appreciateDr. Wendy E. Grus in the Fred Hutchinson Cancer Research Centerfor her excellent English-language editing.

References

[1] A.K. Chaturvedi, D.R. Smith, D.V. Canfield, A fatality caused by accidental produc-tion of hydrogen sulfide, Forensic Sci. Int. 123 (2001) 211–214.

[2] Agency for Toxic Substances and Disease Registry, Center for Disease Control. PublicHealth Statement: Hydrogen Sulfide. Available from: http://www.atsdr.cdc.gov/toxprofiles/tp114-c1-b.pdf, Atlanta, GA, 2006.

[3] M. Ago, K. Ago, M. Ogata, Two fatalities by hydrogen sulfide poisoning: Variationof pathological and toxicological findings, Leg. Med. (Tokyo) 10 (2008) 148–152.

[4] A. Christia-Lotter, C. Bartoli, M.D. Piercecchi-Marti, D. Demory, A.L. Pelissier-Alicot, A. Sanvoisin, G. Leonetti, Fatal occupational inhalation of hydrogen sulfide,Forensic Sci. Int. 169 (2007) 206–209.

[5] L.D. Knight, S.E. Presnell, Death by sewer gas: case report of a double fatality andreview of the literature, Am. J. Forensic Med. Pathol. 26 (2005) 181–185.

[6] C.P. Larson, C.C. Reberger, M.J. Wicks, Unusual cases. 2. The purple brain death,Med. Sci. Law 4 (1964) 200–202.

[7] L. Adelson, I. Sunshine, Fatal hydrogen sulfide intoxication. Report of three casesoccurring in a sewer, Arch. Pathol. 81 (1966) 375–380.

[8] M.J. Ellenhorn, Ellenhorn’s Medical Toxicology: Diagnosis and Treatment ofHuman Poisoning, 2nd ed., Williams & Wilkins, Baltimore, 1997.

[9] M. Campanya, P. Sanz, R. Reig, S. Nogue, J. Obiols, A. Freixa, J. Corbella, Fatalhydrogen sulfide poisoning, Med. Lav. 80 (1989) 251–253.

[10] PPG Industries, Inc. Product Bulletin: Sodium Hydrosulfide. Available from:http://corporateportal.ppg.com/NA/Chemicals/CAD/ProductInformation/Bull/English/EN, Monroeville, PA, 2005.

[11] S. Kage, H. Ikeda, N. Ikeda, A. Tsujita, K. Kudo, Fatal hydrogen sulfide poisoning at adye works, Leg. Med. (Tokyo) 6 (2004) 182–186.

[12] US Chemical Satety and Hazard Investigation Board. Investigation Report: Geor-gia-Pacific Corp. Hydrogen sulfide poisoning, Pennington, AL. Available from:http://www.csb.gov/completed_investigations/docs/CSB_GeorgiaPacificFINAL.pdf, Washington, D.C., 2002.