Sudden death of a 15-year-old girl due to fulminant type 1 diabetes mellitus—Diabetic ketoacidosis induced cerebral edema?

• We reported a case of sudden death of fulminant type 1 diabetes mellitus.
• The histology of liver and kidney are interesting in type 1 diabetes.
• Postmortem biochemistry examination was useful for diabetic identification.
• Fulminant type 1 diabetes mellitus is a new clinical entity.

Sudden death from fulminant type 1 diabetes mellitus is uncommon in forensic practice. Here we report the sudden death of a 15-year-old girl who presented with vomiting, fever and abdominal pain and died unexpectedly. Postmortem examination showed severe pancreatic islet destruction, cerebral edema and lipid vacuolization of the epithelium of the renal proximal tubules and liver cells. The biochemical analysis in reserved heart blood and vitreous fluid indicated the elevated levels of glucose and ketone bodies and lower glycosylated hemoglobin and C-peptide. The cause of death was attributed to fulminant type 1 diabetes mellitus which led to diabetic ketoacidosis-associated cerebral edema. This report suggested that the histological examination of the pancreas, liver and kidney, insulin immunohistochemistry, as well as biochemical analysis could be useful for the diagnosis of diabetes related death.