Beyond the Boundaries of Forensic Toxicology - the Use of an Atypical Consultant in a Rare Case of Cerberin Poisoning

A severely decomposed body was found partially submerged in a creek. A bag of brown fibrous seeds was found nearby. Postmortem examination revealed saponified soft tissues and assorted skeletal elements without evidence of ante- or perimortem trauma. Anthropological, dental, and investigative evidence identified the decedent as a 31-year-old man who had been reported missing approximately two months prior after a suicide note was found at his residence. Investigation indicated he had purchased Cerbera seeds from the Internet. The fruits of the Cerbera “suicide” tree contain the toxin cerberin, a cardiac glycoside, which can induce heart block and lethal arrhythmias. Extensive putrefaction of the tissues and a lack of appropriate laboratory reference standards precluded identification of cerberin on postmortem toxicology. The seeds found at the scene were sent to a research botanist who identified them as Cerbera manghas L. of the plant family Apocynaceae. Based on these findings, the cause of death was determined to be cerberin poisoning. We are not aware of previously reported cases of cerberin poisonings within the United States, even though its use for suicidal and homicidal means has been well documented in eastern Asia and the Indian Ocean regions. The relative ease of obtaining these seeds through the Internet may result in deaths anywhere in the world. This case highlights the difficulties in identifying the putative toxin in postmortem samples when unusual and exotic poisons are used. Atypical consultants, a botanist in this particular case, may allow appropriate determination of the cause and manner of death.