An unusual case of cut throat injury and poisoning by penco-nazole – suicide or homicide? Medico-legal considerations and toxicological aspects

In some circumstances, forensic pathologists encounter cases of violent death where distinguishing between homicide, suicide, or accidental death is particularly complex. A multidisciplinary approach is essential to correctly identify the manner, circumstances, and cause of death. Often, the analysis of complex suicides raises doubts about the circumstances of death. In particular, the differential diagnosis between complex suicide and homicide is not always easy. We present here a case of a 73-year-old man found moribund in a rural farmhouse with a cut throat injury. Death occurred shortly after arrival at the hospital. The autopsy and toxicological results also documented penconazole poisoning. The case highlights the complexity of assessing the cause and manner of death in certain instances, requiring the integration of all available autopsy data and investigative information. Furthermore, the histological and toxicological data seem to suggest a severe nephrotoxicity of penconazole in humans. This aspect can have a strong clinical and toxicological relevance, also in terms of safety and biological monitoring.