HomeMy WebLinkAboutEppard_Son Autopsy
Decedent: Matthew J. Eller Case: W21-1383
Sex:
Race:
Male
White
Age:
22 years
Date of Birth: 03/08/1999
Date Pronounced Dead:
Time Pronounced Dead:
11/10/2021
2000 hours
Date of Exam: 11/11/2021
Time of Exam: 0730 hours
County: Muskegon
Pathologist: Joseph Prahlow, M.D.
Autopsy Procedure: Complete
Identification:
Persons in Attendance:
Identification Tags
Jenna Jones, Assistant
Matt Bombich, Photographer
Ben Root, Medical Student
Josh McGarry, Medical Student
Sung Jik Cha, Medical Student
Postmortem Examination Report
Cause of Death:
TOXIC EFFECTS OF MITRAGYNINE
Manner of Death:
ACCIDENT
Western Michigan University Homer Stryker M.D. School of Medicine
Department of Pathology
300 Portage Street • Kalamazoo, MI • 49007
269.337.6173 med.wmich.edu
CIRCUMSTANCES:
History that the decedent stood up after playing a game of cards and then collapsed and
demonstrated seizure-like activity. All resuscitative efforts failed. He had a history of kratom
use.
RECEIPT OF REMAINS:
The body is received in the facility on 11/11/2021 at 0710 hours. The body is received in a
secured body bag with an identification tag bearing the decedent’s name and a sealing device
marked with the number “2335758.”
EXTERNAL EXAMINATION:
The body is identified by tags on the body bag and the right ankle. Photographs and x-rays are
taken. The body is received wearing a pair of athletic shorts, a pair of boxer briefs, and a pair of
socks. There is no jewelry.
The body is that of a well-developed, well-nourished, white male, whose appearance is
compatible with the stated age of 22-years. His body is 73-inches long and weighs 138-pounds.
The body is cold, rigor is fully developed, and the posterior lividity is partially fixed. The scalp
hair is up to approximately 5-inches in length, brown, and wavy. There is emesis within the hair.
The irides are hazel, and there are no petechiae of the bulbar or palpebral surfaces of the
conjunctivae. There is no beard or moustache. The ears, nose, and lips are unremarkable except
that the earlobes are pierced. The teeth are natural and in good condition. The neck is
unremarkable. The chest is symmetrical. The abdomen is flat and unremarkable. The external
genitalia, anus, and perineum are unremarkable. The penis is circumcised, and the testicles are
descended into the scrotum. The extremities are well developed, symmetrical, and unremarkable.
The back is unremarkable. The skin is unremarkable.
IDENTIFYING MARKS AND SCARS:
There is a tattoo of the name “Hannah” on the right triceps region.
EVIDENCE OF THERAPY:
Oral laryngeal mask airway
Multiple EKG pads
Defibrillator pads
Intravenous line, left antecubital fossa
Bandage, left third finger
EVIDENCE OF INJURY:
There is a less than 1/8-inch superficial incised wound of the tip of the left third finger. There is a
3/16-inch in greatest dimension linear abrasion of the proximal knuckle of the left second finger.
There is an approximately ¼-inch in greatest dimension vertical linear laceration of the lower lip.
There is a less than 1/8-inch crusted excoriation of the right shin. There is a less than 1-inch in
greatest dimension subtle, left frontal subscalpular hemorrhage, but no other head trauma.
INTERNAL EXAMINATION:
BODY ORGAN WEIGHTS:
Brain 1480 grams Heart 340 grams
Right Lung 600 grams Left Lung 500 grams
Liver 1840 grams Spleen 230 grams
Right Kidney 150 grams Left Kidney 170 grams
BODY CAVITIES:
The thoracic and abdominal organs are in their normal anatomic positions. The body cavities
contain no adhesions or abnormal collections of fluid.
HEAD AND CENTRAL NERVOUS SYSTEM:
The scalp, subscalpular area, and skull are unremarkable except for the subtle left frontal
subscalpular hemorrhage. The dura and dural sinuses are unremarkable. There are no epidural,
subdural, or subarachnoid hemorrhages. The leptomeninges are thin and delicate. The cerebral
hemispheres are symmetrical with an unremarkable gyral pattern; however, there is diffuse
swelling. The cranial nerves and blood vessels are unremarkable. The brain is retained for Lieber
neuropathological examination. The spinal cord is not examined. The pituitary gland is
unremarkable.
LIEBER EXAM (from report):
The dura mater included with the specimen includes a portion of right and left calvarial dura with
the superior sagittal sinus, and the falx cerebri, and dura including and adjacent to the torcula.
The dura and dural sinuses are unremarkable, with no sinus thromboses, neomembranes, or mass
lesions. The cerebral and cerebellar hemispheres are symmetrical with no evidence of softening
or atrophy. The cortical sulci are somewhat effaced from cerebral swelling. The leptomeninges
are smooth and transparent. There is no evidence of transtentorial, subfalcine, central
diencephalic, or external herniation. The cerebellar tonsils are prominent, consistent with diffuse
brain swelling. The blood vessels of the Circle of Willis show no atherosclerosis with no
aneurysms, vascular anomalies, or malformations. The cranial nerves are present and
unremarkable. Serial coronal sections of the cerebral hemispheres demonstrate well demarcated
gray and white matter structures. The cortical ribbon is of normal thickness and the centrum
semiovale is intact throughout, with no focal lesions. The medial temporal lobe structures
including the hippocampus are bilaterally symmetric and effaced somewhat from brain swelling.
There is no significant atrophy or evidence of mesial temporal sclerosis. The deep gray matter
structures are anatomically intact without focal lesions. The ventricles are symmetrical with no
evidence of hydrocephalus. Serial axial sections of the brainstem reveal pigmentation of the
substantia nigra and locus ceruleus appropriate for age, unremarkable brainstem nuclei and white
matter tracts, and no focal lesions. Midsagittal section of the cerebellar vermis and serial
parasagittal sections of the cerebellar hemispheres are unremarkable. The dentate nucleus of the
cerebellum is present and unremarkable
NECK:
The soft tissues and prevertebral fascia of the neck are unremarkable. The hyoid bone and larynx
are intact. The tongue is unremarkable.
CARDIOVASCULAR SYSTEM:
The intimal surface of the aorta is free of atherosclerosis. The aorta, its major branches, and the
great veins are normally distributed. The pericardium, epicardium, and endocardium are smooth,
glistening, and unremarkable. There are no thrombi in the atria or ventricles. The foramen ovale
is closed. The coronary arterial system is right predominant and is free of atherosclerosis;
however, the proximal left anterior descending coronary artery demonstrates “tunneling”. The
atrial and ventricular septa are intact. The cardiac valves are unremarkable. There is slight
biventricular dilatation (right greater than left). The myocardium is dark red-brown and firm,
with no focal abnormalities.
RESPIRATORY SYSTEM:
The upper airway is unobstructed, but does contain small amounts of gastric contents. The
laryngeal mucosa is smooth and unremarkable, without petechiae. The pleural surfaces are
smooth and shiny. The pulmonary arteries contain no emboli. The major bronchi are
unremarkable except for the presence of some gastric contents. Sectioning of the lungs discloses
a dark red-blue, mottled, somewhat congested parenchyma.
HEPATOBILIARY SYSTEM:
The liver is covered by a smooth, glistening capsule. The parenchyma is dark red-brown and
moderately congested. The gallbladder contains no calculi. The extrahepatic biliary ducts are
unremarkable.
DIGESTIVE SYSTEM:
The esophageal mucosa is gray, smooth, and unremarkable. The stomach contains 250 mL of tan
semi-fluid substance. The gastric mucosa has normal rugal folds and there are no ulcers. The
small and large intestines are unremarkable. The appendix is present. The pancreas is
unremarkable externally and on sectioning.
GENITOURINARY SYSTEM:
The subcapsular surfaces of the kidneys are smooth and slightly lobulated. The cortices are of
normal thickness. The calyces, pelves, and ureters are unremarkable. The urinary bladder
contains 75 mL of clear, yellow urine. The mucosa is gray, smooth, and unremarkable. The
prostate gland is unremarkable. The testicles are unremarkable.
ENDOCRINE SYSTEM:
The thyroid and adrenal glands are unremarkable externally and on sectioning.
RETICULOENDOTHELIAL SYSTEM:
The spleen is covered by a smooth, blue-gray, intact capsule. The parenchyma is dark red. The
lymph nodes are unremarkable. The thymus is unremarkable.
MUSCULOSKELETAL SYSTEM:
The clavicles, ribs, sternum, pelvis, and vertebral column have no fractures. The diaphragm is
intact.
MICROSCOPIC EXAMINATION:
LUNGS – Hyperexpanded alveolar spaces; bronchial mucosal hemorrhage; focal chronic
bronchial inflammation.
THYROID – Variably-sized follicles; dark colloid.
ADRENAL, LIVER, THYMUS, HEART, KIDNEY, PANCREAS – Unremarkable.
BRAIN (per Lieber report) – Unremarkable adult brain.
SLIDE KEY:
A: Adrenal, liver, thymus
B: Lungs
C: Heart, kidney
D: Pancreas, thyroid
(BRAIN slides as per Lieber report)
VITREOUS ELECTROLYTES:
Sodium 118 mEq/L
Potassium 7.5 mEq/L
Chloride 124 mEq/L
Urea nitrogen 17 mg/dL
Creatinine 1.05 mg/dL
Glucose <35 mg/dL
TOXICOLOGY:
FEMORAL BLOOD - Mitragynine - 2100 ng/mL
Caffeine - 0.85 mcg/mL
Cotinine - Positive
FINAL FINDINGS:
I. Toxic effects of mitragynine
II. Not found: Anatomic explanation for death
CONCLUSION:
Based upon the autopsy findings and the history as available to me, it is my opinion that
Matthew Eller, a 22-year-old white male, died as a result of the toxic effects of mitragynine.
__________________________________
Joseph A. Prahlow, M.D.
January 4, 2022