A case of axonal form of Guillain-Barré syndrome associated with anti-GM1b IgG antibody following Penner 4 Campylobacter jejuni infection

A 48-year-old man with an extensive history of alcoholism was found dead at home. He was lying face down on a carpet. There was evidence of gastric aspiration at autopsy and histologic examination. The distribution of ethanol was very unusual (concentrations in mg/100 mL or mg/100 g): femoral blood, 257 and 273 (two samples); heart blood, 643; vitreous humor, 763; urine, 84; bile, 616; liver, 250; and gastric, 4660 (2470 mg/53 g). In addition, this man ingested isopropanol, and, according to the history, may also have ingested acetone in the form of nail polish remover. The distribution of both isopropanol and acetone was as expected, which was approximately in proportion to the aqueous content of the respective tissues. It is proposed that agonal or postmortem aspiration of the ethanol-rich vomitus and postmortem fermentation could account for the apparently elevated concentrations of ethanol in heart blood and bile. The elevated vitreous ethanol could be explained if ethanol diffused across the eye in the agonal phase or postmortem from gastric aspirate in the carpet. The relatively low urinary ethanol concentration would be consistent with a recent binge-drinking episode, which allowed only a limited time period for excretion into an already partially full, but relatively ethanol-free, bladder.