17-year-old male with a history of paraplegia secondary to a gunshot wound to the T1 vertebra. He died at home without medical assistance and a judicial autopsy was ordered.
a) External examination: atrophy of the four extremities and ankylosis of the hands, decubitus ulcers with necrotic tissue at bitrocantéreo and sacrum level. Tracheostomy cannula at cervical level. He was carrying a urinary catheter connected to a collection bag containing urine with a striking purple colour.

b) Internal examination: brain with significant weight gain (1,875 g) with cerebral oedema pattern (flattening of gyri and convolutions). Heart of normal weight (325 g) with discrete dilatation of right cardiac cavities and presence of mural thrombi. Right pleural and interlobular adhesions and pulmonary thromboembolism in the left branch of the pulmonary artery. Lungs were slightly overweight (D: 640 g; I: 600 g) with moderate to severe congestion and oedema. There was no evidence of pulmonary infarction. Normal kidney weight (D: 180 g; I: 130 g) with poor cortico-medullary differentiation, haemorrhage in the medullary area and areas of purplish discolouration with purulent material exiting through the renal pelvis. The urinary bladder showed 400 cc of cloudy urine, foul odour associated with greenish-cream coloured sediment at the bottom with a purulent appearance.

c) Complementary examinations:
- Toxicological analysis negative in blood, urine and vitreous humour samples.
- Microbiological analysis. Urinary sediment culture showed growth of Proteus vulgaris.
d) Cause of death: Pulmonary thromboembolism was considered the immediate cause of death, urinary tract infection as an intermediate cause and paraplegia as the underlying cause.