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Pathology Update 2025

159 - Wischnewski spots: found only in hypothermic deaths?

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Forensic Pathology

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Abstracts/Presentation Description

Nadia Lee1, Lee Chin Thye1
1Forensic Medicine Division, Health Sciences Authority, Singapore

Wischnewski spots (WS) have been described as a classic finding of hypothermic deaths at autopsy, though their specificity and sensitivity for hypothermic deaths remains debated1. Recently, several case reports have emerged demonstrating a possible link between the formation of WS and other conditions, including diabetic ketoacidosis2,3. We describe a case report of a death due to diabetic ketoacidosis with WS at autopsy. The deceased had been found in a hotel room, with estimated ambient temperature no less than 20 degrees Celsius. Biochemical analysis of post-mortem samples of urine yielded significantly elevated levels of glucose and ketones. Histological examination showed basal vacuolisation in renal tubular epithelial cells. The cause of death was given as diabetic ketoacidosis.

References:

  1.  Sacco MA, Abenavoli L, Juan C, Ricci P, Aquila I. Biological Mechanisms behind Wischnewsky Spots Finding on Gastric Mucosa: Autopsy Cases and Literature Review. Int J Environ Res Public Health. 2022;19(6):3601. doi: 10.3390/ijerph19063601. 
  2.  Lai JK, Hickey TB. Wischnewski Spots in a Case of Hyperosmolar Hyperglycemic State. Am J Forensic Med Pathol. 2023;44(3):216-9. doi: 10.1097/PAF.0000000000000829
  3.  Yataco-Marquez BV, Kemp WL. Wischnewsky Spots in a Death From Diabetic Ketoacidosis. Am J Forensic Med Pathol. 2022;43(3):e21-2. doi: 10.1097/PAF.0000000000000745

Contribution statement: Both authors contributed to the autopsy and formulation of cause of death, the selection of the case report and to the writing of the abstract. 

Speaker/Presenting Authors

Authors

Submitting/Presenting Authors

Dr Nadia Lee - Forensic Medicine Division, Health Sciences Authority (Singapore)

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