Tödliche Essstörung: Akute Intoxikation durch den Verzehr von Eibennadeln

In the pre-Christmas period a 37-year-old man was found lying lifeless on his bed by the duty nurse in an assisted living facility for handicapped persons. Numerous conifer leaves were found in the bed as well as in the mouth of the patient. The medical history of the man included pica, autism and a mild form of epilepsy. The medicolegal autopsy revealed layers of greenish needle-like leaves and twigs reaching from the lower part of the esophagus through to the colon. The autopsy findings showed no perforation due to foreign bodies, no signs of obstruction or other mechanical damage of the digestive tract or indications of a bolus death. Blood congestion of the internal organs as well as pulmonary and cerebral edema provided unspecific indications of poisoning. Due to the inconspicuous results of the systematic toxicological analysis, a targeted analysis for taxine from the yew tree (secondary pseudo-alkaloids in Taxus spp.) was performed by liquid chromatography tandem mass spectrometry (LC-MS/MS) using the method described by Frommherz et al. The total blood level of taxine B and isotaxine B was 236 μg/l. This concentration confirms an acute poisoning and provides the explanation for the death as a result of oral intake of yew leaves.