POSTMORTEM IDENTIFICATION OF SILDENAFIL IN URINE AND VISCERAL TISSUE IN A FATAL CASE OF ACUTE CARDIOVASCULAR INSUFFICIENCY: A FORENSIC TOXICOLOGICAL CASE REPORT

Abstract

Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil are widely used for erectile dysfunction and are frequently obtained without medical supervision, sometimes as undeclared adulterants in dietary supplements marketed for sexual enhancement. Their vasodilatory and hypotensive effects can precipitate acute cardiovascular events in men with pre-existing, occasionally undiagnosed, cardiac disease. We report the case of a 48-year-old man found dead in a hotel room in the Andijan region, with sildenafil tablets recovered at the scene. Autopsy revealed diffuse coronary atherosclerosis and myocardial changes consistent with acute cardiovascular insufficiency, without evidence of mechanical trauma. Blood, urine, and visceral tissue (liver, gastric wall) were submitted for forensic-chemical analysis using a combined protocol of alkaline liquid–liquid extraction, two-system thin-layer chromatography (TLC), colour (spot) tests, and ultraviolet (UV) spectrophotometry, adapted from a previously described qualitative method for sildenafil and tadalafil in counterfeit supplements and from classical toxicological isolation techniques. Sildenafil was not detected in blood but was identified in urine and liver extracts, with chromatographic mobility, colour reactions, and UV absorption maxima consistent with the reference standard. The forensic-medical conclusion attributed death to acute cardiovascular insufficiency, with sildenafil use considered a contributing factor. This case illustrates both the diagnostic value and the interpretive limitations of a low-cost, instrumentation-light screening protocol applicable in regional forensic laboratories lacking access to chromatography–mass spectrometry, and underscores the forensic relevance of PDE5 inhibitors in sudden cardiac death.