Lethal Endomyocarditis caused by chronic "Krokodile" Intoxication

"Krokodile" is a home-made opioid drug obtained by synthesizing desomorphine from codeine and combining it with other low-cost additives.Initially introduced in the former Soviet countries. It was then imported to Western Europe as a heroin substitute. To our knowledge , this is the first report of an italian case of lethal kroko0dile abuse, that occured in a 39-year -old man, who died suddenly after transportation to the Emergengy Department (ED) for hyperthermia associated with sweating, dyspnoea and tachicardia. Post-mortem examination revealed extensive necrotic ulcerative lesions on the forearms, and autopsiey showed a hypertrophic heart with ample endocardial vegetation on the aortic valve and patency of the foramen ovale.Histopathological examination of the hearth showed ulcero-vegetative lesions of the aortic valve with an abscess on the annulus and extension to the periaortic adipose tissdue, as well as diffuse myocardal interstitial inflammatory neutrophils infiltrates. Toxicological analysis demonstrated a desomorphine metabolitesin urine. On the basis of all findings, the cause of death was ruled to be congestive heart failure caused by endocarditis and myocarditis, correlated with chronic abuse of krokodile.