Fatal Anaphylaxis Following Measles Vaccination: A Forensic Autopsy-Based Case Report
DOI:
https://doi.org/10.48165/iijfmt.2026.24.12.06Keywords:
AEFI, anaphylaxis, measles vaccine, forensic autopsy, mast cells, eosinophils, IgE, sudden deathAbstract
Adverse Events Following Immunization (AEFI), though rare, remain an important area of forensic and public health concern, particularly when death occurs within hours of vaccine administration. We report the case of an individual who died approximately 6–7 hours after receiving a measles vaccine, with no significant comorbidities identified on history. Autopsy revealed features of systemic asphyxia with visceral congestion, and histopathological examination of the injection site demonstrated marked mast cell and eosinophilic infiltration, supported by elevated serum total IgE. Microbiological cultures and Forensic Science Laboratory (FSL)/viscera chemical analysis were negative for infective and toxic causes. Based on the correlation of clinical history, gross autopsy findings, ancillary investigations, and histopathology, the cause of death was certified as anaphylaxis and its complications following measles immunization. This case illustrates the essential role of a systematic, guideline-based AEFI autopsy protocol in establishing causality and excluding alternative causes of death.
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References
World Health Organization. (2019). Causality assessment of an adverse event following immunization (AEFI): User manual for the revised WHO classification. World Health Organization.
Rüggeberg, J. U., Gold, M. S., Bayas, J. M., Blum, M. D., Bonhoeffer, J., Friedlander, S., de Souza Brito, G., et al., & Brighton Collaboration Anaphylaxis Working Group. (2007). Anaphylaxis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine, 25(31), 5675–5684. https://doi.org/10.1016/j.vaccine.2007.02.064 DOI: https://doi.org/10.1016/j.vaccine.2007.02.064
Gold, M. S., Amarasinghe, A., Greenhawt, M., Kelso, J. M., Kochhar, S., Thong, B. Y.-H., Top, K. A., Turner, P. J., Worm, M., & Law, B. (2023). Anaphylaxis: Revision of the Brighton Collaboration case definition. Vaccine, 41(15), 2605–2614. https://doi.org/10.1016/j.vaccine.2023.02.051 DOI: https://doi.org/10.1016/j.vaccine.2022.11.027
Palmiere, C., Tettamanti, C., & Scarpelli, M. P. (2017). Vaccination and anaphylaxis: A forensic perspective. Croatian Medical Journal, 58(1), 14–25. https://doi.org/10.3325/cmj.2017.58.14 DOI: https://doi.org/10.3325/cmj.2017.58.14
Sipahi, S., Ozceker, D., Gokcay, G., Guler, N., & Tamay, Z. (2019). A case of anaphylaxis to measles vaccination in an infant with cow's milk allergy. Pediatric Allergy, Immunology, and Pulmonology, 32(3), 135–138. https://doi.org/10.1089/ped.2019.1033 DOI: https://doi.org/10.1089/ped.2019.0993
Tomassini, L., Ricchezze, G., Gambelunghe, C., Lancia, M., Gramaccia, M., De Micco, F., Fedeli, P., Cingolani, M., & Scendoni, R. (2025). Beyond the numbers: Critical analysis of the role of postmortem tryptase in the forensic diagnosis of anaphylaxis. Journal of Forensic Sciences, 70(6), 2117–2128. https://doi.org/10.1111/1556-4029.70046 DOI: https://doi.org/10.1111/1556-4029.70147
Radheshi, E., Reggiani Bonetti, L., Confortini, A., Silingardi, E., & Palmiere, C. (2016). Postmortem diagnosis of anaphylaxis in presence of decompositional changes. Journal of Forensic and Legal Medicine, 38, 97–100. https://doi.org/10.1016/j.jflm.2015.12.016 DOI: https://doi.org/10.1016/j.jflm.2015.12.001
Wang, X., Yin, C., Su, X., & Su, M. (2020). Reliable postmortem molecular diagnosis of anaphylaxis: Co-localization of mast cell degranulation and immunoglobulin E in allergic throat tissues. American Journal of Forensic Medicine and Pathology, 41(4), 286–291. https://doi.org/10.1097/PAF.0000000000000576 DOI: https://doi.org/10.1097/PAF.0000000000000572
Parmar, P., & Rathod, G. (2024). Adverse events following immunization (AEFI): Current trends, latest autopsy protocol, Indian scenario, and statistics. International Journal of Forensic Sciences, 9(1), 000362. DOI: https://doi.org/10.23880/ijfsc-16000362
Delage, C., & Irey, N. S. (1972). Anaphylactic deaths: A clinicopathologic study of 43 cases. Journal of Forensic Sciences, 17(4), 525–540. DOI: https://doi.org/10.1520/JFS10141J
