Fatal norovirus infection in a patient with congenital adrenal hyperplasia: forensic use of BioFire FilmArray GI panel

Introduction Identifying infections during autopsy is challenging in forensic pathology. Although microbiological testing can assist in diagnosis, distinguishing true pathogens from contaminants is often difficult. Molecular methods, such as PCR, may support diagnostic conclusions. Case description On August 22, 2024, a 30-year-old woman was admitted to the Department of Emergency Medicine, Clinical Centre, University of Debrecen, Hungary, with severe vomiting and diarrhea. Her medical history included treated congenital adrenal hyperplasia. Within 30 min of admission, she developed sudden cyanosis and respiratory insufficiency. Despite resuscitation efforts, the patient died shortly after arrival. Two days before hospitalization, she had collected sewage samples from the Kraszna River (Hungary) as part of her job. According to her colleagues, she did not wear any protective equipment (mask, gloves, or coveralls). The samples were later analyzed at the National Center for Public Health and Pharmacy and tested positive for Norovirus. Findings Postmortem examination, including microbiological and molecular investigations (BioFire FilmArray GI multiplex PCR), confirmed Norovirus infection. These findings supported the hypothesis that viral infection significantly contributed to rapid clinical deterioration. Discussion This case highlights the utility of molecular microbiology in forensic investigations. Multiplex PCR panels, routinely used in clinical diagnostics, can provide valuable evidence in postmortem settings, particularly in acute gastrointestinal deaths where autopsy findings are non-specific. Early patient education in congenital adrenal hyperplasia may prevent fatal outcomes in similar cases.