Legal Medicine 52 (2021) 101896

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Legal Medicine
journal homepage: www.elsevier.com/locate/legalmed

Case Report

Investigation of the skin lesions in lightning strike death

Gennaro Baldino a, Cristina Mondello b, Chiara Stassi a, Cataldo Raffino c, Stefano Vanin d,
Elvira Ventura Spagnolo a, *
a
Section Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of
Palermo, Via del Vespro, 129, 90127, Italy
b
Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, Gazzi, Messina
98125, Italy
c
Legal Medicine Centre of INAIL, Via Roma 419/423, Enna 94100, Italy
d
DISTAV, University of Genoa, Genoa, Italy

A R T I C L E I N F O A B S T R A C T

Keywords Lightning strike-related deaths are unusual, and the victim bodies can present different lesions due to the
Forensic pathology different injury mechanisms associated with this event. Since the post mortem assessment can be challenging, the
Accidental death evaluation of the characteristics of the skin lesions becomes fundamental to reconstruct the event. Due to the
Lightning injuries
paucity of literature on this topic, the authors report the case of a 59-year-old man found dead near his home
Lichtenberg figures
after a thunderstorm. Initially considered a murder by gunshot, the autopsy revealed the typical lightning strike
lesions, also known as Lichtenberg figures. The adequate interpretation of the autopsy data and the histological
evidences allowed to reconstruct the death dynamic and to relate it to a lightning strike. The main lesions due to
lightening are here reported and discussed in order to provide a workflow for the identification of lightening as
cause of death in unwitnessed cases.

1. Introduction
Lightning is a natural phenomenon linked to the atmospheric elec­
tricity, consisting of a large electrical discharge between two bodies with
a high electrical potential difference.
Electricity inflicts injuries when a body becomes part of its circuit.
The different kind and level of injuries depend on many factors such as
the current flows, the exposure time, the skin resistance and the voltage
that can range from low household to high industrial voltage (110 V to
10.000 V), till voltages of 1 MV or higher in discharges of few milli­
seconds, such as in the case of a lightening [1,2].
Six main injury mechanisms by which a lightning can strike human
bodies have been described in literature: 1) direct strike; 2) contact
voltage (contact injury); 3) side-flash; 4) ground current (step voltage);
5) blunt trauma and 6) upward streamer [3–5]. In addition, injuries can
be caused not only by mechanical effects involving the electric current,
but also by thermal damage and barotrauma – although thermal injuries
seldom occur because of the short heat duration, despite the electric
current reaching peaks of thousands of amperes [6,7].
As consequence of the different injury mechanisms, a common and
unique pattern of injuries does not exist which can be defined and used
as diagnostic of lightning as cause of death, especially in unwitnessed
events. In addition, some of the injuries caused by a lightning event can
be, on an external examination of the body, misinterpreted as originated
by other causes. It is also worth mentioning that, due to the very low
frequency of such an event, practitioners are often unprepared for its
detection. In order to contribute to fill this gap, we report a case of death
due to a lightning strike – initially interpreted as a gunshot death – to
highlight the importance for the forensic practitioners to recognize the
injury patterns related to this unusual event, providing in addition a
comparative summary of the main lesions described in literature and
associated with lightening.
2. Case report
The body of a 59-year-old man was found near his home on a public
road, lying on the ground. The physician involved in the preliminary
forensic investigation described the face stained with blood, with two
gunshot-like wounds on the right temporal region, a large laceration in
the axillary region, multiple facial abrasions and partial removal of both

* Corresponding author.
E-mail address: elvira.ventura@unipa.it (E. Ventura Spagnolo).

https://doi.org/10.1016/j.legalmed.2021.101896
Received 25 September 2020; Received in revised form 6 April 2021; Accepted 15 April 2021
Available online 30 April 2021
1344-6223/© 2021 Elsevier B.V. All rights reserved.
G. Baldino et al. Legal Medicine 52 (2021) 101896

auricles. He thus stated the death as due to gunshot injuries. Once

Fig. 1. The back of the jacket (A) showing the laceration at the level of the neck
(white square) and the signs of burn (B).
concluded the investigations at the crime scene, an autopsy was
disposed to assess the cause and manner of death.
Skull and chest X-rays and gunshot residue (GSR) analyses revealed,
respectively, no metallic material inside the body or any evidence
associated to a firearm discharge.
The clothes analysis showed bloodstains on the jacket at the level of
the neck, right arm, and back; in addition, lacerations and burning signs
were observed (Fig. 1).
The autopsy was performed 48 h after the body recovery. The
external examination showed abrasions, lacerations and a large starry-
like injury on the right side of the face (Fig. 2A). Both auricles
appeared completely removed, with necrotic areas (Fig. 2B). Further­
more, in the right clavicle region, a wide area showing composite in­
juries were found: numerous linear blackish burns, partly serpiginous,
among which irregular linear reddish erythema-like patterns (repro­
ducing the so-called Lichtemberg figures) there were (Fig. 2, C and D).
Upon cadaveric inspection, fractures of the right clavicle and from sec­
ond to sixth right ribs were found; injuries were not considered
compatible with gunshots.
On routine histopathology, the skin and the heart showed the most
relevant evidence: in the heart, areas of wavy fibres and coagulative
necrosis were found (Fig. 3A); in the skin, different patterns were
observed, resulting in extensive haemorrhages of the deep and superfi­
cial dermis and coagulative necrosis, associated with flattening and
condensation of all epidermis layers (Fig. 3B). “Brush” polarization with
a spicular appearance of the epidermal surface was highlighted in areas
of coagulative necrosis (Fig. 3C).
On the basis of the autopsy findings, the cause of death was assessed
as cardiac arrest due to arrhythmia determined by a lightning strike.

Fig. 2. Main gross skin lesions observed. The head of the subject showing the stellar-type lesion on the right side of the face and the ear damage with auricle removal
(A,B); linear blackish burns and irregular linear reddish erythema-like patterns (Lichtemberg figures) (C,D).

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G. Baldino et al. Legal Medicine 52 (2021) 101896

Fig. 3. Main histological evidence. Heart: areas of coagulative necrosis (asterisk) and wavy fibers (arrow) (A: H&E, 10×). Face injury: coagulative necrosis (arrow)
associated with flattening and condensation of all epidermis layers (B: H&E, 10x); “brush” polarization (arrow) with a spicular appearance of the epidermal surface
(C: H&E, 20×).

Table 1
Lightning-related injuries characteristics. The reliability parameter, subjectively graded from + to +++, is proposed by the authors to support in the evaluation of
death caused by lightning.
Mechanism Injury Also Caused by Additional Investigations Reliability Reference

Electrical - From superficial, starry-like, to deep - Sharp and/or blunt force injuries; / + Byard et al. [8]
Effect skin injuries; Adukauskiene et al
- Fatal arrhythmias and/or myocardial - Myocardial infarctions and/or other Search for markers of + [17]
necrosis; cardiomyopathies; myocardial ischaemia Resnik et al [19]
- Lichtenberg figures. - Pathognomonic. / +++ Lichtenberg G [20]
Mutter et al [21]
Heat Effect - 1st degree burns; - Fires, explosions; / + Mondello et al [18]
- Superficial charring of the skin. - Contact with electric material. / ++ Kristensen et al [22]
Blast Wave - Eardrum membrane rupture; - Explosions; / ++ Mutter et al [21]
Effect - Internal organs lacerations (e. g., - Explosion, blunt force injuries; / + Figgis et al [27]
lungs and GI tract); Kilbas et al [28]
- Gunshot-like injuries. - Explosions. GSR assessment + Blumenthal R [30]
Blumenthal R [31]

3. Discussion and conclusion
Death due to lightning is an infrequent event with an incidence
varying greatly in relation to the climatic conditions; despite the lack of
data for Europe and Asia, this phenomenon seems to be relevant in the
United States. An analysis of lightning deaths in USA between 2006 and
2019 reported that 418 people were struck and killed; in almost two
thirds of these cases, the accident involved people during outdoor leisure
activities (e. g., fishing, beach activities, camping, etc.) [8]. These ac­
cidents mostly occur during thunderstorms in open places like rural
areas, woodlands and forests. Sometimes, electrocuted bodies can be
found in unusual places, such as in the case reported by Kaliszan et al.
[9] of a man hit by a lightning in the city centre, probably as
consequence of the fact that he was standing on heating metal pipes built
in the ‘80 s. Few cases have also been described in literature where
lightning indirectly struck indoors [10–12].
The mortality rate of lightning ranges between 20 and 30%, with
74% of the survivors suffering from sequelae and permanent damage
[13,14]. In clinical and experimental studies in which the probability of
survival was higher than 50%, it was reported that a rapid current
significantly decreases the energy dissipation within the body, resulting
in the subject survival [15].
Death in lightning victims is mainly due to cardiac or respiratory
arrest [16], rarely to the failure of other organs [4]: the passage of the
current generated by the circuit throughout the body, can indeed affect
all the organs, mostly brain and heart, thus leading to a fatal outcome.

3
G. Baldino et al.
Different types of lightning lesions can be observed on a body,
depending on the injury mechanism (Table 1). Injuries caused by the
heat effect generally appear as first degree burns or superficial charring
of the skin which result, in routine histology, as intra-epidermal or intra-
and subepidermal separation, and coagulative necrosis [17].
Lesions associated with the electrical effect, range from very super­
ficial starry-like injuries to the Lichtenberg figures. The Lichtenberg
figures are branching non-burn lesions considered as pathognomonic
findings of lightning [18]; these injuries are rarely found and are most
commonly observed in survivors [19]. These characteristic signs were
firstly described by G. C. Lichtenberg in 1777 and represent a useful
finding for the assessment of the cause of death, especially when an
unwitnessed lightning event occurs [20,21]. To date, the pathogenesis of
this phenomenon is still poorly understood, though it has been suggested
that they could be the result of the damage and subsequent leakage from
cutaneous blood vessels due to the transmission of the electrical current
through the skin [21]; according to Cooper et al. [7], such lesions may
also be the result of the interaction between the electrons flow and the
metal blood components inside the capillary red blood cells [7].
Other kinds of injuries can also be observed in the ear structures,
including eardrum membrane rupture and burns of the external auditory
canal due to the blast wave and thermal radiation determined by the
lightning [21,22]. To this regard, some authors suggested the usefulness
of otoscopic examinations to evaluate the occurrence of the perforation
of the tympanic membrane [23,24]. Investigations on the eyes by means
of ophthalmic endoscopy or intraocular visions were also proposed since
lightning strike can also determine posterior sub-capsular damage and
retinal detachment [25,26]. Cases reporting the laceration of particular
internal organs by barotrauma, such as lung and gastrointestinal tract,
were also reported – though rare – thus underlining how the blast
overpressure injuries can be a major cause of morbidity and mortality in
lightning [27,28]. Upon autopsic investigation, other authors described
direct hits to the facial district [29].
Occasionally, bullet-like injuries were described as the result of high-
speed flying materials generated by the shockwave [30,31].
Another useful forensic investigation must be carried out on clothes,
which can be partially destroyed or absent [32]: this evidence may fool
unskilled investigators, being mistakenly interpreted as an assault sign.
As for other organs, no specific signs are generally observed. As for
the heart, it is well known that the electric current flow can determine
fatal cardiac arrhythmia or direct necrosis of the myocardium, which
does not represent sensitive enough evidence, thus leading some re­
searchers to test biochemical and immunohistochemical markers, as the
ones already tested for myocardial infarction [33–36]. The serum levels
of and myocardial immunostaining loss for cardiac troponins and heart-
type fatty acid binding protein (H-FABP) are highly sensitive and spe­
cific biomarkers of ischemic myocardial damage and may have a diag­
nostic value in determining the myocardial injury or the cause of death
due to electrocution, especially in the early period [36].
Being the injuries and lesions observed in the present case compat­
ible with those described in literature as related to a lightning strike, the
first hypothesis of a gunshot murder was rejected in favour of a lightning
strike death. Such final diagnosis was further supported by the exami­
nation of the characteristics of the skin injuries, together with the
microscopic skin evidence and the histological findings on the heart. As
for the accident dynamic, both circumstantial data and forensic in­
vestigations suggested that the subject was struck by a lightning, during
a thunderstorm, which hit his head while he was walking along the
street, projecting him meters away from the site of the impact.
The present case study provides an overview of the main injuries
described in literature related to a lightning strike, with special refer­
ence to the Lichtenberg figures, a rare pathognomonic sign that, if
found, can drive forensic practitioners in the assessment of the cause of
death: accordingly, the presence of these injuries can be considered
conclusive in case of unwitnessed accidents. Not less relevant, the case
stresses the importance of having adequate knowledge of the
4
Legal Medicine 52 (2021) 101896
characteristics of the lesions and their production mechanisms to pro­
vide a reliable case analysis.
Ethical approval and Informed consent
Not applicable, this is a post mortem case report. Anyhow the data of
the case was provided respecting the privacy law.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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