A fatal intoxication case due to the serotonin syndrome induced by dextromethorphan and moclobemide overdose

Serotonin syndrome has been known as a disease with a potentially life-threatening condition and which occurs usually drug-related and results from an increase in serotonergic activity in the central nervous system. We experienced a fatal case in which may have led to the development of serotonin syndrome and death by intaking privately imported dextromethorphan and moclobemide, MAOIs. We report an autopsy case, a 44-year-old man was found deceased on the bed of his girlfriend's house by her mother. Beside the victim, there was a bottle, which was presumed to have been personally purchased on the Internet, contained two different types of tablets. There were no findings that suggested the presence of obvious trauma or internal diseases in the judicious autopsy. Additional drug testing was performed, and the concentration of dextromethorphan in heart blood was 37.2 mu g/mL was detected. In addition, the fact that the patient had a high body temperature and intramuscular bleeding at the time of death strongly suggests that he had died due to serotonin syndrome. In this case, the diagnosis of serotonin syndrome was made on the basis of autopsy findings and additional drug testing. In cases of suspected death due to serotonin syndrome, additional drug testing and quantitative evaluation to identify the causative agent would be helpful in the diagnosis.