Forensic Autopsy in a Long-Term Survivor of Abusive Head Trauma: An Unusual Case Report

Background and Clinical Significance: Abusive head trauma (AHT), formerly known as Shaken Baby Syndrome (SBS), is a major cause of morbidity and mortality in infants and young children. While the forensic aspects of acute AHT are well described, autopsy findings in long-term survivors who die later in life remain poorly documented. Case Presentation: We describe a male infant diagnosed with AHT at 2 months of age, who survived with severe neurological sequelae until 19 years. He developed tetraparesis and epileptic encephalopathy, and ultimately died during hospitalization for bilateral pneumonia. Forensic autopsy revealed bilateral acute exudative pneumonia with respiratory failure. Neuropathological examination documented extensive chronic encephalomalacia, gliosis, and microcalcifications consistent with longstanding sequelae of AHT. These findings supported a causal nexus between the abusive head trauma sustained in infancy and the fatal pulmonary complication in adolescence. Conclusions: This case highlights the importance of forensic autopsy in long-term survivors of AHT. Establishing the causal relationship between early abusive injuries and late mortality is essential for both medical understanding and medicolegal evaluation.