4.4 Article

Repeated poisoning of the life partner by thallium - a case of questionable Munchausen by adult proxy syndrome with ensuing attempted murder

Journal

INTERNATIONAL JOURNAL OF LEGAL MEDICINE
Volume 136, Issue 3, Pages 695-704

Publisher

SPRINGER
DOI: 10.1007/s00414-022-02791-4

Keywords

Attempted murder; Hair analysis; Munchausen by proxy; Poisoning; Thallium

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This article describes a case of poisoning with thallium that resulted in severe harm to the male victim. The perpetrator, his female life partner, was sentenced to imprisonment for her actions. The possibility of Munchausen by proxy syndrome as a motivation for the poisoning was discussed but ultimately dismissed.
After the use of thallium as rat poison was banned, the knowledge about the severe and treacherous course of poisonings with this toxic metal has widely been lost. In the present case, the male victim sustained two insidious poisoning attacks in 2017 and 2020 by the perpetrator, his female life partner. In the first poisoning episode, he suffered from increasing heavy pain of the abdomen, stinging pain of both legs, persistent obstipation, hyperesthesia, and, after about 2 weeks, tuft-wise loss of hair as typical symptoms of the thallium poisoning. Within 7 weeks, he was successively examined in six hospitals with a wide variety of diagnostic methods, but a conclusive explanation of the complaints was not found. The possibility of a metal intoxication was then suggested by the perpetrator who privately arranged the analysis of a blood sample with the result of 175 mu g/l thallium. Although a criminal poisoning was assumed, the perpetrator was not identified. After the victim left the perpetrator, she subtly executed a second poisoning attack with thallium sulfate (blood level 1230 mu g/l after 1 day, urine level 4760 mu g/l after 10 days, and hair concentrations 3.26-0.49 from proximal to distal in 9 segments). The perpetrator was sentenced to 10.5 years imprisonment for grievous bodily harm and attempted murder. Because of the behavior of the perpetrator, a Munchausen by proxy syndrome was discussed as a motivation of the first poisoning but was excluded by the psychiatric expert because of a missing antisocial personality disorder.

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