Fatal hyperthermia associated with excited delirium during an arrest

An autopsy case of fatal hyperthermia in a state of excited delirium is reported. On a hot summer night a 39-year-old man was suspected of being a rapist, and police officers and several men attempted to arrest him. He vigorously resisted, but after a 20-min struggle he was ultimately forced into a prone position on the ground with his arms and legs restrained by police officers. He collapsed shortly after being arrested and was taken to a hospital, but was pronounced dead on arrival. His rectal temperature measured 2.5 h after death was 40 °C. At autopsy the body showed a severer degree of postmortem change than after death at a normal body temperature and a similar postmortem interval. Autopsy revealed abrasions and subcutaneous hemorrhages of the head, face, arms, and legs. The heart was dilated and exhibited subendocardial hemorrhages in the left ventricle. The brain and both lungs were congested. Microscopic examination of the lungs revealed intraalveolar edema and hemorrhages. The skeletal muscles showed contraction band necrosis and hyaline degeneration. The liver showed diffuse coarse-droplet fatty infiltration of hepatocytes. Neither addictive drugs nor alcohol were detected from the blood or urine. The suspect was concluded to have died of fatal hyperthermia in a state of excited delirium.