CASE REPORT
Postmortem Increase in Body Core Temperature
How Inaccurate We Can Be in Time Since Death Calculations
Tomáš Vojtíšek, MD, PhD,* Štěpánka Kučerová, MD,† Jan Krajsa, MD, PhD,* Bülent Eren, MD, PhD,‡
Petra Vysočanová, MD,§ and Petr Hejna, MD, PhD, MBA†
Abstract: Postmortem increase in body core temperature is a well-known
phenomenon in forensic practice. Despite this, cases of reliably docu-
mented postmortem hyperthermia are rarely reported in the forensic litera-
ture, and it is still not clear how frequently postmortem hyperthermia
occurs and in which cases we may it predict. In routine forensic practice,
the standard course of body cooling is expected, and the prediction of
normal body core temperature in the time of death is used for back-
calculating the time of death by Henssge method. The unexpected ris-
ing in body core temperature may considerably misguide the estimation
of time since death in the early postmortem period. We present a rare
case of nonviolent death in the hospital with exactly recorded unusual
elevation of body core temperature after death, although the body tem-
perature shortly before the death was normal. In the presented case, the
“standard” cooling of the body began up to 4 hours after death.
Key Words: time since death, postmortem period,
postmortem hyperthermia
(Am J Forensic Med Pathol 2017;38: 21–23)
T he most widely used methods for estimating postmortem in-
terval are measuring postmortem rectal temperature and
back-calculation using the Henssge method, complemented by
the assessment of livores and rigor mortis.1 This estimation may
be complicated during the early postmortem period by the abnor-
mal increase of body core temperature after death. According to
the literature, postmortem hyperthermia occurs nearly in 10% of
violent fatalities.2 The documentation of postmortem hyperther-
mia requires a correct measurement of body core temperature
early after death or recording of abnormally slow body cooling
that does not correlate with the duration of the postmortem pe-
riod.3 The exact monitoring of body cooling in forensic practice
is difficult, and described cases of postmortem hyperthermia are
fairly sporadic. By contrast, suitable conditions for temperature
monitoring, as well as cooling of the body after death, are in hos-
pitals, especially in intensive care units.
In this article, we present a case of expected death in the
hospital, with measured and accurately recorded body temper-
atures both before death and in the early postmortem period.
Manuscript received September 13, 2016; accepted November 13, 2016.
From the *Faculty of Medicine, Department of Forensic Medicine, Masaryk
University, St. Anne's Faculty Hospital, Brno; and †Faculty of Medicine in
Hradec Králové, Department of Forensic Medicine, Charles University,
University Hospital Hradec Králové, Hradec Králové, Czech Republic;
‡Council of Forensic Medicine of Turkey, Bursa Morgue Department,
Bursa, Turkey; and §Faculty of Medicine, Department of Internal
Cardiology Medicine, Masaryk University, University Hospital Brno, Brno,
Czech Republic.
The authors report no conflict of interest.
Reprints: Štěpánka Kučerová, MD, Faculty of Medicine in Hradec Králové,
Department of Forensic Medicine, Charles University, University Hospital
Hradec Králové, Sokolská 581, Hradec Králové 500 05, Czech Republic.
E-mail: kucerovas@lfhk.cuni.cz.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0195-7910/17/3801–0021
DOI: 10.1097/PAF.0000000000000286
Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
An unusual elevation of body temperature after death was doc-
umented, although the body temperature shortly before the death
was nearly normal.
CASE REPORT
A 69-year-old man with an implanted cardioverter defibrilla-
tor (St Jude Medical Promote+, Sylmar, Calif ) and a medical his-
tory of dilated cardiomyopathy, ischemic heart disease, and
chronic heart failure was moved to a hospital when his condition
deteriorated. He was hospitalized in the intensive care unit in a
state of terminal heart failure with the indication of basal therapy.
He was pronounced dead 10 days after admission. Two days be-
fore death, he was given a diagnosis of a skin infection on his
lower legs (erysipelas) caused by Streptococcus pyogenes. The
axillary temperature was measured twice a day during hospital-
ization using a clinical (mercury-free) thermometer. His axillary
temperature was 37.5°C in the evening before death and 37.6°C
at 6:00 AM the next morning when the last temperature measur-
ing before death was noted. Higher temperatures were not re-
corded during hospitalization. Death at 7:00 AM was attributed
to heart disease, and at this time, the temperature of the body
seemed to be within the expected range.
According to the Czech law, the deceased must remain in the
hospital ward for 2 hours after death. In this case, the ambient tem-
perature in the hospital room was 20°C. One hour after death,
nurses started to prepare the body for transport to the Department
of Pathology. They noticed the unusually warm skin of the de-
ceased, and a doctor was called back to the hospital room to verify
death again. The first record of postmortem body temperature was
noted in 1.5 hours after death and peaked at 40.1°C. Remarkably,
the medical staff had concerns about spontaneous combustion of
the body and attempted to cool the body with frozen solutions
placed near the groin. After that, medical staff measured axillary
temperature in 30-minute intervals. The body temperature subse-
quently decreased to the level it was before death: 2 hours after
death, axillary temperature was 39.9°C; 2.5 hours after death, it
was 39.9°C; 3 hours after death, it was 39.3°C; 3.5 hours after
death, it was 38.7°C; and 4 hours after death, it was 37.6°C. This
record is shown in Figure 1, with the assumption of a linear in-
crease in temperature during the initial unmeasured period. The
case was referred to a forensic pathologist, and a medicolegal
autopsy was ordered to clarify the cause of death and to explain
the postmortem hyperthermia.
Autopsy was performed 27 hours after death and revealed a
white man with a height of 186 cm and weight of 90 kg. Postmor-
tem hypostasis of an intensive reddish purple color was observed
on the dorsal part of the body; rigor mortis was fully developed.
Notable in the external examination was the trophic change of skin
on the lower legs, characterized as advanced hyperpigmentation.
No external marks of violence were identified. The internal exami-
nation revealed 300 mL of pleural effusion in the pleural cavity and
150 mL of pericardial effusion. The cardioverter defibrillator was
removed from the subcutaneous tissue in the left subclavicular
www.amjforensicmedicine.com 21
Vojtíšek et al
FIGURE 1. Body temperature before and after death.
region, along with its correctly inserted electrodes from the heart
cavities. Postmortem review of the device did not display any sig-
nificant arrhythmia before death. The heart was enlarged and
dilated, measuring 20  16  5 cm and weighing 915 g. The
myocardium was yellowish with fibrosis and carried numerous
subendocardial scars. Acute ischemia of the heart muscle was
not detected during macroscopic examination. The atherosclero-
sis of the coronary arteries was advanced. Autopsy of the other
internal organs revealed lung edema, chronic congestion in the
liver, and renal cysts. The cause of death was macroscopically
assessed to be heart failure. Histological examination of the heart
showed acute congestion, interstitial fibrosis, hypertrophy and
atrophy of cardiomyocytes, nuclear variation, absence of necrosis
of cardiomyocytes, and lack of inflammatory infiltrates. Microbi-
ological examination of the scrapings from the skin of lower limbs
revealed nothing unusual. The analysis of alcohol blood level and
other toxicology examination were not requested because of the
preceding 10-day hospitalization.
DISCUSSION
A normal living body core temperature is generally 37.2°C,
with fluctuations between 36.7°C and 37.7°C.4,5 After death, a
body core temperature of 37.2°C or higher after the temperature
plateau (a mean interval of 2 hours) indicates postmortem hyper-
thermia.3 Previous experimental studies recording rectal tempera-
ture measurements in the early postmortem period were based on
the bodies of recently deceased persons (with a known time of
death) and a constant ambient temperature.3,6–9
According to the medicolegal literature, postmortem hyper-
thermia is not a unique phenomenon. Initial postmortem elevation
of rectal temperature was reported in 1985 by Hutchins,10 and
Muggenthaler et al3 reported hyperthermia at the time of death in
18 of 84 cases in a study of postmortem rectal cooling. Demierre
et al2 recorded elevated body core temperature in 10% of violent
death cases in a representative study of 744 cases.
Many possible causes of postmortem hyperthermia have been
discussed in the literature. Hyperthermia can result from patholog-
ical processes or from an overproduction of heat within the body.3
Many authors have published cases of postmortem hyperther-
mia related to perimortem pathology.2,11–19 Intoxication and
overdose of drugs are often reported as causes of postmortem
hyperthermia.11–14 Conversely, hypothermia is more commonly
associated with chronic alcoholics or narcotic addicts.15 Violent
incidents resulting in hidden cerebral traumatism, brain trauma
with cerebral hypoxia, polytrauma, and death by asphyxiation
are also suggested as possible causes of increased body tem-
perature after death.2,16 A rise of rectal temperature caused by
22 www.amjforensicmedicine.com
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Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
electricity was excluded in cases of death by low voltage cur-
rent in an experimental study by Haedrich et al.17 Myocardial
infarction, cancers, infection, and fever from a variety of causal
agents can produce pathological conditions before death that
could result in elevated body core temperature at the time
of death.2,18,19
Another well-known condition associated with the elevation
of mean core body temperature is excited delirium. Hyperthermia
is even considered a strong supportive evidence for the diagnosis
of sudden death caused by excited delirium.20
Generally, the spontaneous rise in body temperature after
death is interpreted as a short-term surplus of heat production
from postmortem metabolic processes17 occurring alongside con-
tinuing tissue and bacterial metabolism10 and insufficient ther-
mal loss. In our case, the erysipelas of the lower limbs could be
an acceptable explanation of elevated body temperature after
death; however, this was not demonstrated in the autopsy speci-
mens. There were no other evident pathological or environmental
factors that could explain the abnormal rise in body temperature
after death.
CONCLUSIONS
We have presented here a case of expected cardiac death in
the hospital with precisely recorded postmortem hyperthermia.
The phenomenon of postmortem hyperthermia is well known in
forensic practice, but it is still not entirely clear how frequently it
occurs and in which specific cases we may expect postmortem
hyperthermia. However, rectal body core temperature after death
is measured at the scene as an important forensic evidence, to be
collected rapidly before it begins equalizing with the environment's
temperature. As a rule, the common course of body cooling is
expected in routine forensic practice. As illustrated by our case,
body temperature changes can be grossly unusual and unexpected
and may misinform forensic estimation of time since death in the
early postmortem period.
REFERENCES
1. Kaliszan M, Hauser R, Kernbach-Wighton G. Estimation of the time
of death based on the assessment of post mortem processes with
emphasis on body cooling. Leg Med (Tokyo). 2009;11:111–117.
2. Demierre N, Wyler D, Zollinger U, et al. Elevated body core temperature in
medico-legal investigation of violent death. Am J Forensic Med Pathol.
2009;30:155–158.
3. Muggenthaler H, Sinicina I, Hubig M, et al. Database of post-mortem rectal
cooling cases under strictly controlled conditions: a useful tool in death
time estimation. Int J Legal Med. 2012;126:79–87.
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
4. Henssge C, Madea B. Methoden zur Bestimmung der Todeszeit an Leichen.
Lübeck, Germany: Schmidt-Röhmhild; 1988:159.
5. Henssge C. Precision of estimating the time of death by mathematical
expression of rectal body cooling (author's transl). Z Rechtsmed. 1979;83:
49–67.
6. Henssge C. Estimation of death-time by computing the rectal body
cooling under various cooling conditions (author's transl). Z Rechtsmed.
1981;87:147–178.
7. Al-Alousi LM, Anderson RA, Worster DM, et al. Multiple-probe
thermography for estimating the postmortem interval: I. Continuous
monitoring and data analysis of brain, liver, rectal and environmental
temperatures in 117 forensic cases. J Forensic Sci. 2001;46:317–322.
8. Mall G, Hubig M, Beier G, et al. Supravital energy production in early
post-mortem phase—estimate based on heat loss due to radiation
and natural convection. Leg Med (Tokyo). 2002;4:71–78.
9. Henssge C, Knight B, Krompecher T, et al (Eds). The Estimation of the
Time Since Death in the Early Post-Mortem Period. 2nd ed. London,
England: Edward Arnold; 2002.
10. Hutchins GM. Body temperature is elevated in the early postmortem
period. Hum Pathol. 1985;16:560–561.
11. Bauwens JE, Boggs JM, Hartwell PS. Fatal hyperthermia associated
with cocaine use. West J Med. 1989;150:210–212.
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Postmortem Increase in Body Core Temperature
12. Byard RW, Eitzen DA, James R. Unusual fatal mechanisms in nonasphyxial
autoerotic death. Am J Forensic Med Pathol. 2000;21:65–68.
13. Kortelaine ML, Huttunen P, Lapinlampi T. Urinary catecholamines
in hyperthermia-related deaths. Forensic Sci Int. 1990;48:103–110.
14. Loghmanee F, Tobak M. Fatal malignant hyperthermia associated with
recreational cocaine and ethanol abuse. Am J Forensic Med Pathol.
1986;7:246–248.
15. Shields CP, Sixsmith DM. Treatment of moderate-to-severe hypothermia
in an urban setting. Ann Emerg Med. 1990;19:1093–1097.
16. Nemot EM, Jungreis C, Larnard D, et al. Hyperthermia and
hypermetabolism in focal cerebral ischemia. Adv Exp Med Biol. 2005;
566:83–89.
17. Haedrich C, Ortmann C, Hofmann OR, et al. Influence of electricity on
post-mortal body temperature. Forensic Sci Int. 2006;160:173–177.
18. Tuma R, DeAngelis LM. Altered mental status in patients with cancer.
Arch Neurol. 2000;57:1727–1731.
19. Kluger MJ, Kozak W, Conn CA, et al. Role of fever in disease. Ann N Y
Acad Sci. 1998;856:224–233.
20. Mash DC, Duque L, Pablo J, et al. Brain biomarkers for identifying
excited delirium as a cause of sudden death. Forensic Sci Int. 2009;190:
13–19.
www.amjforensicmedicine.com 23