Abstract
Accidental hypothermia can be fatal, and is often associated with confusion and paradoxical undressing. Wischnewski spots are a classic manifestation of hypothermia at autopsy.
Keywords: autopsy, Hypothermia, Wischnewski spots
Wischnewski spots are a classic post‐mortem manifestation of accidental hypothermia. Clinical symptoms and signs of accidental hypothermia include agitation, confusion and paradoxical undressing.
1. CLINICAL IMAGE
A 54‐year‐old man was found deceased in his home during winter following a period of methamphetamine intoxication. In the hours prior to his death, a witness stated that he appeared paranoid and was heard shouting and banging on the floorboards. He was subsequently located deceased in a bedroom wearing only an unbuttoned shirt, with a pedestal fan fallen next to his body. His clothes were on the bathroom floor, and there was damage to the shower rail.
Post‐mortem examination revealed multifocal gastric mucosal hemorrhages; so‐called Wischnewski spots. (Figure 1) Records from the local meteorological service showed the minimum temperature around the time of death to be 3.6°C.
FIGURE 1.
Clinical image of the stomach at autopsy revealing characteristic Wischnewski Spots
Wischnewski spots are a classic manifestation of hypothermia at autopsy but extremely rarely reported in living individuals. Pathogenesis has been attributed to disturbances in microcirculation, ischemia, and reperfusion injury. Exposure of the hemorrhagic lesions to gastric acid causes the typical brown hematinic pigmentation macroscopically and histologically. A role for stress has also been implicated. Sensitivity and specificity for hypothermia remain poorly defined.1
Additional features supporting the diagnosis of hypothermia include scene disturbance and abrasions to the lower limbs, attributable to a hypothermia‐induced confusional state.
CONFLICT OF INTEREST
We have no conflicts of interest to declare.
AUTHOR CONTRIBUTIONS
KF: involved in writing and editing of the manuscript. PR: involved in data collection and editing of the manuscript. SW: involved in data collection and editing of the manuscript.
2. ETHICS STATEMENT
Informed written consent was obtained from the patient's next of kin prior to submission and publication.
ACKNOWLEDGEMENTS
We sincerely thank the patient's family for allowing us to share his story with an aim to contribute to the medical literature.
Flabouris K, Russell P, Wills S. Wischnewski spots in a case of accidental hypothermia. Clin Case Rep. 2021;9:11–4. 10.1002/ccr3.3797
DATA AVAILABILITY STATEMENT
Not applicable.
REFERENCE
- 1.Bright F, Winskog C, Byard RW. Wischnewski spots and hypothermia: sensitive, specific, or serendipitous? Forensic Sci Med Pathol. 2013;9:88‐90. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Not applicable.