In an unusual case published in a report in the Journal of Forensic and Legal Medicine, a Portuguese woman was found to have died from a toothpick stuck to her throat.

The 50-year-old unidentified woman from Coimbra went to the local hospital complaining that she felt something was stuck inside her throat ever since she ate a meal of bread and salami. The doctors carried out X-rays and a closer examination of her throat but discovered nothing out of the place. However, the uncomfortable feeling persisted and eventually the doctors prescribed her to go through a psychiatric evaluation, believing that it was “all in her head.”

The doctors initially suspected the woman to suffer from globus pharyngeus, the sensation of feeling a lump in the throat due to contraction of the strap muscles of the neck. Since the woman had a history of psychological illness in the past, after she became a widow, physicians wanted her to get checked by a psychiatrist. However, when the results came back, it was established that she was mentally stable.

Next, she was told she was suffering from a common cold. The doctors gave her some antibiotics and asked her to come back for further treatment if the symptom continued. Five days later, the woman was found dead, lying face down in the bathroom of her home. There were wounds on her head and nose and her pajamas were covered in blood.

Since her longtime boyfriend lived with her, her family immediately began suspected foul play. It was not immediately clear whether a formal complaint was lodged against him.

“Sudden, unexpected or of unknown cause deaths, especially when blood is found at the scene, may give rise to unfounded early speculation,” Dr. César Lares dos Santos, a pathologist at the National Institute of Legal Medicine and Forensic Sciences in Portugal, said.

He added that that wound on her head was caused by hitting the bathroom floor, while that on her nose was due to her falling on her face while wearing glasses.

During a post-mortem, the examiners noticed the skin around her neck had turned green. They cut open the area and found a puss-covered piece of toothpick and two puncture wounds inside. They concluded that inflammation caused by toothpick had interfered with the vital nerves controlling her brain, heart and lungs, and resulted in her suffering a cardiac arrest.

Toothpick
A Portuguese woman died from a toothpick stuck to her throat. This is a representative image of toothpicks. Pixabay

Lares dos Santos said that although there have been cases of people accidentally swallowing toothpicks in the past, none of them, according to his team’s knowledge, had resulted in punctures to the throat and the patient’s death. “Traumatic lesions to the esophagus are relatively uncommon in adults,” he said, Mail Online reported.

He added that the toothpick was not detected by the doctors in the local hospital because tiny items such as coins can be missed in x-rays. That's why, he said, medical professionals needed to be extra-vigilant.

“This case is also a very important reminder for clinical practitioners. First, to always maintain a high degree of suspicion towards less usual pathological scenarios. Second, to avoid diagnostic biases such as those related to psychiatric disorders,” he said.