Fatal Coronary Vasculitis and Acute Myocardial Infarction Associated With Chronic Amphetamine Use: A Forensic Autopsy Case Report.

Sudden unexpected death in young adults is a significant challenge in forensic pathology. While atherosclerotic cardiovascular disease is the most common cause of sudden cardiac death, rare chronic inflammatory conditions such as coronary vasculitis are important and often overlooked. Amphetamine use is emerging as a factor linked to severe cardiovascular complications, including arrhythmia, myocardial infarction, and vasculitis. We report the sudden death of a 27-year-old male with no medical history of cardiac illness. Postmortem autopsy revealed acute myocardial infarction with no evidence of severe coronary atherosclerosis. Histopathology of the coronary arteries demonstrated active vasculitis, with significant luminal stenosis estimated at 70-80%, accompanied by dense inflammatory infiltrates, causing disruption of the arterial wall. Blood toxicological analysis confirmed the presence of toxic amphetamine levels of 1,008 ng/mL. This case report highlights coronary vasculitis as a rare but lethal cause of sudden cardiac death. It emphasizes the need for comprehensive histopathological examination in all forensic autopsies, particularly when typical atherosclerotic findings are absent. This case report contributes to the literature on the cardiotoxic effects of amphetamine and urges forensic pathologists to maintain a high index of suspicion for drug-associated inflammatory vascular disease in the context of stimulant abuse to ensure accurate determination of the cause of death.