Psychological Autopsy and Necropsy of an Unusual Case of Suicide by Intravenous Toluene

Toluene (methylbenzene; volatile hydrocarbon) is an industrial solvent that causes major injury to the lungs; the organ being the first capillary bed encountered. We report an unusual case of suicide by a 24-year-old male, paramedical professional, with fatal outcome within 16 h of intentional, intravenous self-administration of toluene, with clinical presentation of acute respiratory distress syndrome. Psychological autopsy revealed severe depressive disorder and solvent (inhalant) abuse, with marital disharmony as the precipitating stressor for suicide. Necropsy revealed diffuse congestion of internal organs like lungs and liver, epicardial petechial hemorrhages, and gastric hemorrhages. Treatment of toluene poisoning includes supportive care as no specific antidote is available. Early and aggressive management may be conducive to a favorable outcome with minimal residual pulmonary sequelae. Relevant literature of toluene poisoning was identified via PubMed, PubChem, ToxNet, Hazardous Substances Data Bank (HSDB), Embase, and PsycINFO. To our knowledge, this is the first case of suicide by intravenous administration of toluene in the literature.