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Background AMB-FUBINACA is a synthetic cannabinoid that has been associated with periodic outbreaks of acute poisonings, but few fatalities. In late May, June and July 2017 Auckland, New Zealand, experienced an outbreak of deaths associated with AMB-FUBINACA that continued at a rate of about 2–3 per month through February 2019. The aim of this study was to define the demographic, circumstantial, pathological and toxicological characteristics of this outbreak. Methods All records of the Northern Forensic Pathology Service, Auckland Hospital, were reviewed in which the word “AMB-FUBINACA” was referenced, including initial police reports, autopsy reports and toxicology reports. Recorded data included age, sex, race/ethnicity, times and locations, cause of death, autopsy and toxicology findings, and a brief summary of the circumstances of death. Descriptive statistics were performed using IBM® SPSS® Statistics Version 24 and Microsoft® Excel® Version 14.7.2. Findings Sixty-four cases were identified. One sudden infant death and five cases where cause of death was due to trauma were excluded. Of the remaining 58 cases, 88% were male. Mean age was 42 years. In 95% of the deaths, AMB-FUBINACA alone or in combination with alcohol or another drug was listed as the primary or contributory cause of death. In 41 cases postmortem blood concentrations of AMB-FUBINACA acid were available, ranging from 1000 ng/mL, mean 229 ng/mL, median 140 ng/mL. Comorbidities identified included mixed intoxications (29%), heart disease (47%) and obesity (16%). A mental health diagnosis was reported in 50%, and 40% were on antipsychotic medications. Interpretation This study presents characteristics, comorbidities and toxicological findings in a unique outbreak of deaths associated with the synthetic cannabinoid AMB-FUBINACA in Auckland, NZ. Funding All work was funded as part of the usual employment of the authors in their respective institutions. No special funding sources are reported.

The diagnosis of systemic lupus erythematosus (SLE), a chronic inflammatory autoimmune disorder, is usually made by a combination of physical and laboratory findings including autoimmune se-rology. Pulmonary and pleural involvement in SLE is common and the finding of LE cells in pleural fluid cytology is highly specific for SLE. LE cells are neutrophils that contain phagocytosed debris from dead or injured cells that have been targeted by anti-DNA antibodies. We present a 26-year-old female with known Sjogren’s syndrome who presented with right-sided pneumonia and pleural effusion. Cytological examination revealed an exudative pleural effusion within which occasional LE cells were identified, leading to the diagnosis of SLE. This case demonstrates the importance of intense screening of cytological samples in identifying a vital clue to the diagnosis of SLE.

Idiopathic diffuse pulmonary ossification is a rare condition characterised by widespread osseous metaplasia within the lungs. It is usually asymptomatic and often diagnosed at autopsy. There have been a limited number of case reports in the literature. This report presents a case of idiopathic diffuse pulmonary ossification diagnosed at autopsy in a 76-year-old gentleman who died of a ruptured myocardial infarct. Macro-scopically the lungs appeared to show extensive parenchymal ossification. The presence of heterotopic bone was confirmed histologically. A review of published literature on this unusual entity is presented.

Intravascular large B-cell lymphoma (IVLBCL), a subtype of diffuse large B-cell lymphoma, is a rare entity characterised by proliferation of malignant lymphocytes within the intravascular compartment usually without involvement of lymph nodes. It has a heterogeneous clinical presentation and aggressive, often fatal, clinical course. As such the diagnosis is often made at autopsy. This case report presents a 46-year-old male in whom the diagnosis of IVLBCL affecting multiple organs was established at autopsy. The variable presenting and clinical features of this entity are discussed with the aim of heightening the awareness of this aggressive disease.