Unexpected death of a patient with rheumatoid arthritis complicated by a cervical deformity

Unuma, Kana; Harada, Kazuki; Nakajima, Makoto; Ito, Takako; Okutsu, Kosuke; Yoshida, Ken-ichi

doi:10.1016/j.legalmed.2010.06.001

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Volume 12, Issue 5 , Pages 242-245, September 2010

Unexpected death of a patient with rheumatoid arthritis complicated by a cervical deformity

Kana Unuma
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Research Fellow of the Japan Society for the Promotion of Science (JSPS), Tokyo 102-8471, Japan
Kazuki Harada
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Corresponding author. Address: Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Tel.: +81 3 5841 3367; fax: +81 3 5841 3366.
Makoto Nakajima
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
Takako Ito
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Health Services Management and Policy, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Kosuke Okutsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
Ken-ichi Yoshida
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan

Received 15 January 2010; received in revised form 21 May 2010; accepted 2 June 2010. published online 15 July 2010.

Abstract

An elderly female with a 43-year history of rheumatoid arthritis died 2weeks after the onset of chest discomfort, electrolyte disturbance, and interstitial pneumonia. She had frequent premature ventricular contractions, fluctuating heart rate, and hypotension. Ischemic heart disease and interstitial pneumonia were excluded as the cause of death based on clinical course and autopsy findings. A severe cervical deformity with myelopathy likely contributed to circulatory instability, possibly through injury to the intra-spinal sympathetic nervous system, which can induce cardiovascular instability and suppress respiratory function. This likely led to death.