Unassisted smothering in a pillow

We report the case of a 33-year-old man admitted to a psychiatric hospital because of paranoid schizophrenia. The man was found dead lying in his bed with the face pressed against a pillow and with elevated buttocks. The autopsy did not reveal a cause of death. The histological findings displayed the signs of the haemorrhagic–dysoric syndrome with acute emphysema; these findings are pathognomonic of obstructive asphyxia. The adverse effects of the neuroleptics demonstrated by the toxicological findings may have accelerated the loss of consciousness and facilitated the unusual position of the body. On the basis of the clinical history, the autopsy findings, the histological features and the toxicological results, asphyxia due to smothering was diagnosed as the cause of death.