Fatal heat stroke in a child entrapped in a confined space

• Heatstroke must be considered as a possible cause of death in confinement cases.
• There is no specific sign of heatstroke at autopsy.
• The diagnostic of heatstroke relies on the exclusion of other possible causes of death.
• A physiological study can help establish that death resulted from heatstroke.

We report the case of a child succumbing to heatstroke caused by confinement in an icebox. The post mortem examination found cyanosis and hematomas indicating that the child had tried to get out of the container. The temperature of the body was higher than it should have been considering the rigor and delay before post mortem examination. The autopsy showed no significant injury and toxicological tests were negative. A physiological study etablished that death resulted from heatstroke, not a lack of oxygen or CO2 poisoning. We conclude that heat stroke should be considered as a possible mechanism of death even in the absence of context of environmental hyperthermia. We recommend that in these situations involving confinement, establishing the mechanism of death should be done not only on the basis of a detailed post-mortem examination to rule out other causes of death, but also based on complete physiological investigations.