Case report: Fatal fluoride intoxication – clinicopathological correlation and autopsy findings

Abstract

Acute fluoride intoxication is a rare but highly lethal condition, whose early diagnosis 
is challenging due to the nonspecific nature of initial symptoms. We present the case of a 
23-year-old Paraguayan woman, previously healthy, who ingested several compounded 
capsules containing fluoride. Hours later, she developed gastrointestinal symptoms, loss of 
consciousness, and cardiorespiratory arrest, dying despite resuscitation efforts. Autopsy 
revealed cerebral edema, pulmonary edema with hemorrhage, gastric erosions with blood 
content, and visceral congestion. Histological examination confirmed diffuse pulmonary 
edema and hemorrhage, gastric foveolar erosions, and congestion of the liver, spleen, and 
kidneys. Clinical laboratory findings prior to death showed severe hypocalcemia, electrolyte 
disturbances, anemia, and elevated transaminases. The integration of clinical, biochemical, 
and pathological findings confirmed acute fluoride intoxication as the cause of death, even in 
the absence of direct serum level determination. This case highlights the irreplaceable role of 
autopsy in medico-legal contexts and provides relevant evidence to support improvements in 
pharmaceutical regulation and health system response to fluoride intoxications. Furthermore, 
it represents a valuable contribution to the strengthening of forensic toxicology in Paraguay by 
underscoring current diagnostic limitations and the need to optimize resources in this field.