Smurfs: Forensic aspects

Objective The Smurfs (French: Les Schtroumpfs; Dutch: De Smurfen) is a Belgian comic centered on a fictional colony of small, blue and human-like creatures that live in mushroom-shaped houses in the forest. Sometimes, in the course of forensic activity, some cases sound like this comic when patients or victims exhibit a spectacular blue appearance. We report two cases of such situation. Cases histories (1) The corpse aspect of a 52-year-old dead man displays a impressive intense blue color, including mucosa and conjunctiva. A bottle containing a blue liquid is found close to the corpse. At the autopsy, all fluids and organs are of the same spectacular blue color. (2) A 62-year-old alive woman displays an inhomogeneous blue aspect on several body areas. Her medical history includes breast cancer, bipolar disease and anorexia. Blue spots appeared 10 years ago after a coccyx trauma with an upward progress on the body. Genital and oral mucosa are affected while several areas remain healthy. Methods Toxicological investigations, including screening for organic and mineral substances, are performed in biological samples (postmortem samples in case 1, blood and urine in case 2) using GC-MS, LC-MS/MS, LC-HRMS and ICP-MS. In case 2, a biological check-up and a skin biopsy are performed. Results (1) Positive results consist in therapeutic or infratherapeutic blood levels of codeine (109 μg/L), morphine (1 μg/L), meprobamate (1 mg/L) and pregabaline (3.8 mg/L). The blue liquid in the bottle is identified as acid blue 9 dye (or brilliant Blue FCF) that is used as a food coloring (E133). Additional Results from the police investigation include the discovery of a Compo bleu™ container. This acid blue 9 dye highly concentrated solution (500 g/L) is usually intended to be added to herbicide/pesticide liquid preparations in order to spot temporarily treated areas. The cause of death remains finally unclear, but could be related to a massive ingestion of this (although reputed non-toxic) concentrated substance. (2) Biological check-up (comprising liver and renal parameters, calcium and phosphorus homeostasis, ceruloplasmin level…) reveals no abnormality. Toxicological analyses reveal numerous psychoactive drug intakes (zolpidem, clonazepam, hydroxyzine, gabapentine). Skin biopsy discloses abundant black pigment phagocyted by histiocytes at the dermo-hypodermic level, without any inflammatory infiltrate. Electronic microscopy of skin biopsy reveals a heterogeneous intracellular material with clear vacuoles bordered with granulation (carbon was identified in this granulations using X-ray) [1] . Final diagnostic concludes in self-tatoo practices using a colloidal carbon solution in a psychiatric context. Such product (colloidal carbon 10% water solution, Sterimark™), which is easily accessible on Internet, is medically used to spot mammary tumors before radiotherapy. Conclusion Smurfs do not exist in real life and our small experience illustrated by these two cases strongly suggests that those who want to look like Smurfs are cheaters.