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Question #134 (10/3/2025)

National Association of Medical Examiners 
Educational Activities Committee

Submitted by Dr. Sam Engrav, (AP/CP Resident Pathologist, PGY-1, Mayo Clinic, Rochester, MN), Dr. Fabiola Righi (Medical Examiner, Southwestern Institute of Forensic Sciences, Dallas, TX) and Dr. Reade Quinton (Associate Professor, Mayo Clinic, Rochester, MN).
1.A 64-year-old man with a past medical history significant for HIV (on antiretroviral medication), depression, and possible ischemic cardiac injury was reported to have agitation, confusion, tremors, and diaphoresis prior to becoming unresponsive. He was pronounced deceased at home. An empty bottle of prescription medication was noted at the scene. Autopsy was significant for the above finding in the small bowel in addition to 400 mL of similar pink-tan granular material in the stomach.

Which of the following is the most likely mechanism of death?