Tongue coating and sudden death during hospitalization – A case report of fatal vasovagal reflex (bolus death)
Tongue coating is associated with aspiration pneumonia, particularly in long-term inpatients; however, it is not typically recognized as a direct cause of death. We report a recent case in which extensive accumulation of tongue plaque led to exfoliation and subsequent incarceration in the larynx, resulting in sudden death. The patient was a 70-year-old man who was emergently transported to a university hospital due to a right thalamic hemorrhage. Following admission, he remained bedridden and died suddenly on the 13th day of hospitalization. During tracheal intubation, a solid tissue mass was located in the larynx. Autopsy revealed two large, elastic masses measuring 3 × 2 × 0.7 cm and 2.7 × 1.5 × 0.5 cm within the larynx. Notably, there were no typical signs of asphyxiation, such as facial congestion or petechiae. The cause of death was determined to be sudden cardiac arrest due to the vasovagal reflex as a bolus mechanism triggered by the laryngeal incarceration of the exfoliated tongue coating. Sudden deaths can occur in hospitalized or nursing home patients, and a thorough investigation is essential to distinguish between sudden natural deaths and accidental or non-natural causes, such as suffocation. This case highlights that excessive tongue coating can, in rare instances, directly lead to death. Therefore, patients prone to heavy tongue coating require more meticulous oral care than is typically provided to prevent unexpected fatal outcomes.
