The European Council of Legal Medicine (ECLM) on-site inspection form allows the collection of data relevant to the identification, collection, sampling and preservation of all elements that, during the on-site inspection, may be useful as forensic evidence. The aim of this study is to assess the completeness of the information collected in a large number of on-site inspections, the records of which were drawn up without the use of the ECLM on-site inspection form, in order to verify the usefulness and the application of this form. The authors present a multicentre study involving 20 Italian forensic medicine institutes. For each institute, the reports of on-site inspections carried out without the use of the ECLM on-site inspection form were collected and a forensic pathologist was asked to analyse the individual cases and to identify, for each case, the presence or absence of information regarding all the points examined by the ECLM on-site inspection form. A practical database was prepared and sent to each institute for this analysis. Data were collected and analysed from a total of 1721 on-site inspection reports. Our results document that certain items on the ECLM on-site inspection form are not always investigated in reports written without the use of this tool. The use of the ECLM on-site inspection form proves to be a valid tool to assist the forensic pathologist during the on-site inspection. We therefore hope that the forms developed by the ECLM will be systematically adopted in the forensic practice of the forensic pathologist.

West Nile virus (WNV) is an arthropod-borne flavivirus first identified in 1937. Over time, WNV has spread globally and is now endemic in Italy. Although most human WNV infections are asymptomatic (80%), less than 1% progress to a neuroinvasive disease with high mortality rates. This case involves a 45-year-old woman with post-surgical hypoparathyroidism and Sjögren’s syndrome who developed severe encephalomyelitis linked to WNV, leading to ventilator-associated pneumonia and death. Neuropathological findings revealed a bilaterally cribriform thalamus and reddish punctate lesions near the dentate nucleus of the cerebellum. The trachea and bronchial hilum branches contained whitish foamy liquid. The left lung showed multiple brownish-violet areas, with whitish regions at dissection. The heart appeared unremarkable. A detailed neuropathological examination focused on areas involved in motor control pathways. Tissue samples were stained with hematoxylin and eosin and trichrome techniques, and immunohistochemistry was performed using CD68, CD3, and CD20. A significant damage was observed in the lenticular nucleus and motor thalamus, with prominent concentric vascular calcifications. The cerebellar cortex showed near-total depletion of Purkinje cells. In the spinal cord, CD68 and CD3 positivity was noted in the lateral funiculi, anterior horns, and Clarke’s column. Lung findings showed pulmonary edema, chronic emphysema, and bronchopneumonia. The observed CD3 and CD68 positivity confirms that WNV spreads trans-synaptically along motor control pathways. We speculate on the potential molecular mechanisms by which hypoparathyroidism and Sjögren’s syndrome may have played a role in the neuroinvasive progression of the disease.

Acute chorioamnionitis is a placental inflammatory condition often implicated in adverse pregnancy outcomes, including intrauterine death. The histopathological identification of maternal and fetal inflammatory responses (MIR and FIR) is critical for diagnosis and understanding potential causal mechanisms. Chorioamnionitis frequently warrants medico-legal investigation, particularly for suspected medical malpractice. Two forensic cases of intrauterine fetal death with histological finding of acute chorioamnionitis are presented. Each case has been investigated with a complete autopsy with histological examination of fetal organs and placenta. The investigations were conducted following the Royal College of Pathologists' Guidelines on autopsy practice for fetal death and the European Guidelines for forensic investigations involving suspected healthcare professional liability. In Case 1, histopathology revealed acute necrotizing chorioamnionitis associated with chorionic vasculitis, funisitis and fetal organ involvement (stage 3/grade 2 MIR; stage 2/grade 1 FIR), supporting a causal role in fetal death. In Case 2, only focal chorioamnionitis with minimal fetal inflammatory response (stage 2/grade 1 MIR; stage 1/grade 1 FIR) was detected. A definitive and certain causal relationship with the death cannot be established due to the absence of systemic fetal involvement. No substandard medical care was identified in either case. These cases underscore the importance of integrating clinical and histological data to determine the pathophysiological significance of chorioamnionitis in fetal death. The evaluation of FIR and organ involvement are critical for distinguishing between causal and incidental findings. Thorough histopathological evaluation is essential for accurate cause of death determination and medicolegal assessment.