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CASE REPORT

Fatal poisoning by ingestion of a self‑prepared oleander leaf infusion Anna Carfora1   · Raffaella Petrella1 · Renata Borriello1 · Lucia Aventaggiato2 · Roberto Gagliano‑Candela2 · Carlo Pietro Campobasso1 Accepted: 2 November 2020 © The Author(s) 2020

Abstract An unusual case of poisoning by the ingestion of oleander leaves is reported. A 71 year old male laboratory technician committed suicide at home in this unusual manner. At the death scene a steel pan and other paraphernalia, used for the extraction of oleandrin and other cardiac glycosides from the leaves of the Nerium oleander plant were found. Toxicological investigations for oleandrin, oleandrigenin, neritaloside, and odoroside were performed by LC–MS/MS on all biological samples (peripheral blood, vitreous humor, urine, liver, gastric contents) and on the yellow infusion found at the death scene. In all samples, toxic levels of oleandrin were detected (blood 37.5 ng/mL, vitreous humor 12.6 ng/mL, urine 83.8 ng/mL, liver 205 ng/mg, gastric content 31.2 µg/mL, infusion 38.5 µg/mL). Qualitative results for oleandrigenin, neritaloside, and odoroside were obtained. Oleandrigenin was present in all tissue samples whereas neritaloside and odoroside were absent in the blood and vitreous humor but present in urine, liver, gastric content, and in the leaf brew. The purpose of this study was the identification of oleandrin and its congener oleandrigenin, detected in the vitreous humor. The blood/vitreous humor ratio was also calculated in order to assess of the likely time interval from ingestion to death. According to the toxicological results death was attributed to fatal arrhythmia due to oleander intoxication. The manner of death was classified as suicide through the ingestion of the infusion. Keywords Poisoning · Nerium oleander leaves · Oleandrin analysis · Oleandrin/oleandrigenin in vitreous humor · Liquid chromatography-tandem mass spectrometry

Introduction * Anna Carfora [email protected] Raffaella Petrella [email protected] Renata Borriello [email protected] Lucia Aventaggiato [email protected] Roberto Gagliano‑Candela [email protected] Carlo Pietro Campobasso [email protected] 1



Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania “L. Vanvitelli”, Via L. Armanni, 5, 80138 Napoli, Italy



Department Interdisciplinary of Medicine (DIM), Forensic Toxicology Laboratory, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy

2

Nerium oleander (or oleander) is an ornamental evergreen shrub belonging to the family Apocynaceae, widespread in the Mediterranean area, but also in subtropical and tropical regions. Oleander contains, in each of its parts (seeds, roots, leaves, flowers, fruits, branches, and stem), several cardiac glycosides (CGs), also defined as cardenolides [1]. Oleandrin is the most relevant toxin of the Oleander plant and it is the only one available as a pure standard [2]. The chemical formula of o