Discovery of an Intravenous Drug Injection Site: A Meticulous Cutaneous Examination Provides the Forensic Dermatology Clue to a Diagnosis of Homicide

The unsuspected homicide in a decedent was considered when the meticulous cutaneous examination of the dead person resulted in the discovery of an intravenous injection site. A 24-year-old woman was found dead in her home. Initial assessment by the crime scene investigator and detective could not determine either the cause or the manner of death. The law enforcement personnel returned to the scene after the assistant medical examiner found a single intravenous needle puncture site during her cutaneous examination of the left antecubital fossa of the dead woman. Additional evidence located near the deceased woman's home included a bag with a butterfly needle and its plastic cap, a syringe with blood staining on the inside, and two empty vials of propofol. The investigators were able to identify the nurse who had obtained the vials of propofol, and the forensic pathologist recommended that propofol also be included with the other drugs routinely being evaluated during the toxicology studies. The discovery of an intravenous needle mark wound lead to further evaluation of the death scene and resulted in the appropriate toxicology studies being ordered that the cause of death was due to propofol, making this a homicide. A meticulous and through examination of the cutaneous and mucosal surfaces may provide the essential forensic dermatology clue to either the cause of death or the manner of death or both.