Discovery of an intravenous drug injection site: A meticulous cutaneous examination provides the forensic dermatologic clue to a diagnosis of homicide.

An unsuspected homicide in a decedent was considered when the meticulous cutaneous examination of the deceased 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. 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 stain on the inside, and two empty vials of propofol. The investigators were able to identify the nurse who had obtained the propofol vials, and the forensic pathologist recommended that propofol be included among the other drugs routinely being evaluated during the toxicology studies. The discovery of an intravenous needle mark led to further evaluation of the death scene, resulting in the appropriate toxicology studies being ordered, which revealed that the cause of death was due to propofol, making it a homicide. A meticulous and thorough examination of the cutaneous and mucosal surfaces may provide an essential forensic dermatologic clue to the cause of death, the manner of death, or both.