Escherichia coli in medicolegal autopsy causing symmetrical peripheral gangrene and psoas abscess

Postmortem microbiology (PMM) plays a crucial role in identifying infectious causes of death, which have significant legal and clinical implications. Not only determining the cause of death, PMM is vital in identifying infectious pathogens providing valuable medical insights. This case series presents two medicolegal autopsy cases where Escherichia coli infections led to rare and severe complications: Symmetrical peripheral gangrene (SPG) and psoas abscess. The first case involves a 28-year-old female hospitalized for 35 days after allegedly consuming sedatives. Postmortem findings included gangrene in her hands and feet and extensive lung consolidation with pus nodules. Blood cultures identified E. coli, while lung swabs revealed Klebsiella pneumoniae and Candida spp. The second case involves a 32-year-old female experiencing abdominal pain and breathing difficulties who died en route to the hospital. The autopsy revealed congested lungs and a psoas abscess, with blood cultures confirming E. coli infection. E. coli, typically associated with urinary tract infections, can cause severe complications such as SPG and psoas abscess. SPG involves ischemic damage to extremities without central vessel occlusion, often linked to septicemia and disseminated intravascular coagulation. Psoas abscesses result from hematogenous spread or direct extension from adjacent structures. These cases highlight the need to consider atypical pathogen presentations in critically ill patients. Recognizing E. colis' potential for rare, fatal complications emphasizes the importance of thorough microbiological analysis during autopsies to improve diagnostic accuracy, guide clinical management, and inform public health strategies. Integrating PMM into routine autopsy protocol is essential for advancing medical and forensic knowledge.