Disulfiram is widely used in the management of alcohol dependence; however, its interaction with ethanol can result in severe and life-threatening complications. This case report highlights the fatal outcome of a disulfiram-ethanol reaction (DER) in a patient with preexisting cardiac comorbidities. A 51-year-old male, recently discharged from a rehabilitation center after five months of treatment, resumed alcohol consumption despite strict medical warnings. This led to a severe DER, culminating in hypotensive shock and multi-organ failure, ultimately proving fatal despite aggressive medical intervention. Autopsy findings revealed acute tubular necrosis (ATN) secondary to persistent hypotension, exacerbated by preexisting dilated cardiomyopathy and previous myocardial infarction. This case underscores the risks of disulfiram therapy in patients with significant cardiovascular disease and highlights the need for alternative pharmacologic strategies to prevent alcohol relapse in high-risk individuals.
Keywords: acute tubular necrosis; alcohol dependence; cardiac comorbidities; disulfiram-ethanol reaction; forensic pathology.
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