Sudden death of amiddle aged male due to pulmonary tuberculosis exaggerated by minor trauma (Assault): A medico-legal case report and review of the literature

Tuberculosis is the prototype of the granulomatous inflammatory diseases, caused by Mycobacterium tuberculosis. Immune reactions are usually involved in the development of granulomas (referred to as a tubercle in this disease) often characterized by the presence of central caseous necrosis, rare in other granulomatous diseases. Although it is uncommon but when exaggerated by some trauma it may account for sudden death.

In this case a middle aged male, 40 years old, suffering from unknown chronic lung disease, with alleged history of assault, beaten by three persons, resulting in bleeding from mouth & nose was declared brought dead in hospital. On Postmortem examination externally there were multiple small bluish contusions over anterior aspect of chest. Internal examination revealed multiple cavities filled with caseous material in upper lobes of both lungs. Stomach contained about 30 ml of coffee ground fluid. Other cavities & organs were normal. Histopathological examination of sections of lungs revealed cavities with white caseous material. Microbiological examination showed features of Tuberculosis pneumonia (AFB positive slides). This case is reported to highlight the medico-legal issues regarding role of minor trauma due to assault in sudden death of a person suffering from chronic disease & the importance of Histopathology & microbiology to ascertain the cause of death.