CASE REPORT
A Unusual Lightning Death in an Indoor Setting
A Case Report
Francesco Ventura, MD, PhD, Rosario Barranco, MD,
Alessandro Bonsignore, MD, PhD, and Francesco De Stefano, MD
Abstract: Death due to lightning strikes is infrequent, above all indoors.
Some cases may take on a medical legal interest due to the unusual and un-
common circumstances in which they occur. The authors report an ex-
tremely rare case of electrocution occurred inside a house in a rural area.
A 53-year-old man was reached by an electrical discharge originating from
lightning while he was doing renovation work on a cottage. In this case, the
correct interpretation of the autopsy and histological aspects and the atten-
tive analysis of the circumstantial and environmental data led to the correct
diagnosis of death and to the reconstruction of the dynamics with which it
occurred. It was in fact possible to reconstruct that during a violent thunder-
storm, lightning, discharging from the bottom upward formed an electric
arc. The victim, who was close to metal objects (sawhorses), was struck
on the left foot and the current exited from the right hand passing through
the heart causing immediate death.
Key Words: lightning strike, burns, accidental death
(Am J Forensic Med Pathol 2017;38: 1–4)
L ightning-strike injuries are fascinating and unpredictable natu-
ral phenomena with potentially devastating effects. It is esti-
mated that worldwide there are 1800 active thunderstorms at any
given moment, with up to 44,000 thunderstorms producing
8 million lightning flashes per day.1
Lightning can be considered a form of high-voltage direct
current. It is a transfer of an electrical charge between polarized
positive and negative charges within a storm cloud and the
ground. It results from an elevated electric potential difference be-
tween the excess of negative charges at the bottoms of thunder-
clouds that repel freely moving electrons at the underlying
surface on the ground, thus positively charging it by induction.
The lightning discharge eventually occurs when the electrical re-
sistance of air is exceeded.2 The physical processes that take place
in and around a thundercloud generate static electricity between
individual water droplets/ice particles that collectively, at a consid-
erable scale, involve prominent surfaces/structures on the ground
below so as to create a massive electrical circuit. Before the actual
bolt, the electrons from the cloud follow a zigzag path toward the
ground branching at various locations. This is known as a stepped
leader, by which the charges present on the earth's surface are
attracted upward forming a so-called streamer: their encounter oc-
curs at approximately 150 to 200 m above the ground. The flow of
electrons occurs at 50-ms intervals, via the route of lowest electri-
cal resistance, in a sort of ionized channel whose diameter varies
from a few millimeters to 20 cm. Due to the extreme speed of
the phenomenon, it appears continuous to the human eye, unable
Manuscript received February 10, 2016; accepted September 2, 2016.
From the Department of Legal and Forensic Medicine, University of Genova,
Via de' Toni 12, 16132 Genova, Italy.
The authors report no conflict of interest.
Reprints: Francesco Ventura, MD, PhD, Department of Legal and Forensic
Medicine, University of Genova, Via A. de Toni 12, 16132 Genova, Italy.
E-mail: francesco.ventura@unige.it.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0195-7910/17/3801–0001
DOI: 10.1097/PAF.0000000000000273
Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
to appreciate separate flashes of light at rates faster than a tenth of
a second. Between clouds of different potential, an electrical dis-
charge can occur, commonly called a lightning flash. The physical
characteristics of lightning are: a spatial discharge length that
varies from 8 to 10 k, an average discharge diameter of 20 cm,
an electrical potential of several million Volts, an intensity that os-
cillates between 10,000 and 110,000 A, and a temperature equal
to 8000°C.3 The injury produced to the victim struck by lightning
principally derives from electrothermal phenomena, though indi-
rect mechanical effects are not trivial. The majority of deaths
caused by lightning strikes are due to cardiac arrest and/or electro-
thermal injuries. Most cases occur outdoors; nevertheless, some
cases do occur indoors.
Herein, the authors report the case of a lightning-strike injury
of a previously healthy middle-aged man fatally struck while
working indoors in a cottage.
CASE REPORT
A 53-year-old man was renovating his cottage, working
alone. In the evening, after receiving no answer from him, the
family resorted to calling the police. Upon their arrival, with the
forensic pathologist, the man was lying on his right side between
2 metallic sawhorses. Tetany was ascertained inasmuch as during
the investigation of the scene, which took place roughly 2 hours
after the incident, the corpse revealed an unusual rigidity, which
could not be overcome by manual force, thus inexplicable by rigor
mortis alone. The surroundings gave no indication that any fire
had started. His tools were scattered about, and the furnishings
present in the room showed no signs of burns. However, fire-
fighters found no damage to the circuit breaker or any detectable
electrical malfunction. The structure of the cottage consisted in a
rudimentary system of walls with steel beams connecting the ex-
terior of the structure to the central portion of the cottage through
the roof. The beams may have played an essential role in conducting
electrical current during the storm. The metal tools in the room,
directed toward the ceiling, may have further facilitated the
current (Fig. 1).
The engineer that examined the scene suggested that light-
ning had entered the cottage through the beams and created an
arc at the spot where the victim was working.
The meteorological office reported that a thunderstorm had
occurred in the area a few hours before the incident. Moreover, an-
other person was also struck by lightning while crossing a bridge
in the same village.
Careful medical-legal and engineering evaluations make it
possible to establish that the lightning reached the metal beams,
placed within the walls although protruding to the exterior. The
electrical current discharging from the bottom upwards formed
an electric arc. The victim, who was close to metallic objects (ie,
sawhorses), was struck on the left foot, and the current exited from
the right hand passing through the heart (Fig. 2).
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Ventura et al Am J Forensic Med Pathol • Volume 38, Number 1, March 2017

FIGURE 1. Scene investigation autopsy findings. A, A general view of the scene. The man was lying on his right side between 2 metal
sawhorses. The furnishings present in the room showed no signs of burns. B, The body was covered by burnt pieces of his clothes.
First-degree, second-degree, and third-degree burns, predominantly in the abdominal region, proximal thighs, and genitalia. C, Diffuse tetany
with the exit site on the right thumb. D, Burnt shoes, particularly the sole of the left shoe, thought to be the entrance site.

Clothing and Autopsy Findings
The autopsy showed the corpse of a man (175 cm in height,
weighing 75 kg) with multiple signs of lightning-strike injury. The
body was covered by burnt remnants of clothing. External exam-
ination revealed burnt shoes, particularly the sole of the left shoe,
thought to be the entrance site. First-degree, second-degree, and
third-degree burns were present in the abdominal region, proximal
thighs, and genitalia, comprising approximately 70% of the whole
body surface area. The beard, body hairs, and scalp were singed
with unaffected areas of skin. Lichtenberg striae were present
on the left thigh. Macroscopically, the right thumb showed
deepithelialization and yellowish-ochre discoloration. The tongue
was oedematous, and the papillae were scorched. Internal

FIGURE 2. Scene investigation autopsy findings. A-B, Burnt and singed hair and beard. C, A general view of the abdomen and thighs.
D, First-degree, second-degree, and third-degree burns in the abdominal region.

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Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
FIGURE 3. Histological findings. A, Myocardial fragmentation (H&E, 10). B, Myocardial lightning injury and disarray (H&E, 20). C,
Epidermal necrosis and dermal homogenization (20). D, Epidermal thermal injury with blisters (H&E, 4). H&E, hematoxylin-eosin.
examination revealed congestion of all the major organs with
edema of the lungs. Moreover, autopsy showed the absence of
soot in the trachea and diffuse muscle tetany. Blood tests revealed
a low level of carboxyhemoglobin (3.9%).
Toxicological analysis excluded the presence of alcohol,
amphetamine-methamphetamine, 3,4-methylenedioxy-methamphet-
amine, tetrahydrocannabinol, cocaine, opiates, methadone, barbitu-
rates, benzodiazepines, neuroleptics, and tricyclic antidepressants.
Histological Findings
Histological examination revealed myocardial contraction
band necrosis, fragmentation, and cellular disorder. Moreover, this
analysis showed an acute pulmonary emphysema and edema. On
the right thumb, lightning-strike injury produced epidermal necro-
sis, scabs, and blisters, with homogenization of the superficial and
deep dermis (Fig. 3).
According to the autoptic and histological findings, the cause
of death was determined to be by acute ventricular failure secondary
to atmospheric electricity (lightning) with contextual skin burns.
DISCUSSION
Lightning strikes the Earth in excess of 100 times per second,
that is, 8 million times a day.4 In the United States, this phenome-
non causes approximately 300 accidents and 100 deaths per year.5
The National Weather Service of the United States currently esti-
mates 70 deaths/year, and a mortality rate of 10%. Furthermore,
city dwellers are thought to be at less risk than those in rural
areas.6 With very few exceptions, individuals were struck by light-
ning while engaged in outdoor activities. People working on con-
struction sites or in agriculture, as well as those who play golf or
go fishing, swimming, or camping are particularly at risk. Fatal
lightning strikes are more common in the summer and autumn,
between May and September, more often in the early afternoon
and evening.7
Lightning strikes produce a mortality rate of 10% to 30%
with a 76% risk of long-term consequences in survivors.8 The
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Lightning Death
contact period of lightning with the victim is approximately a
10,000th to a 1000th of a second.
Lightning may cause injury via a diversity of mechanisms:
direct strike, “side flash,” wherein the lightning strikes another ob-
ject and then “jumps” onto the victim, or by conduction through
another object.2
In some cases, a phenomenon called flashover can occur, in
which part of the discharge is diverted to the surface of the body
because attracted by metallic conductors and body moisture. Sev-
eral authors9 believe that this is a protective phenomenon because
it allows the current to flow along the surface of the body, instead
of through it.
In several studies, death by lightning strike occurs immedi-
ately10 due to cardiac asystole or ventricular fibrillation.11,12 The
electrical current causes a “countershock” which simultaneously
depolarizes all myocardial cells. Histological examination reveals
a mixture of necrosis, hemorrhage, eosinophilic myocarditis,13,14
and possible cardiac disarray. At the same time, respiratory ar-
rest can be caused by muscle paralysis and respiratory center
depression. Aspiration pneumonia, pulmonary edema, and dif-
fuse alveolar hemorrhage can also occur. These findings may
result from diffuse central nervous system depolarizations,
which leads to a faulty regulation of the gag reflex, or from re-
suscitation attempts.4,15 Lightning-strike injury can also trigger
an intense catecholamine release, with ensuing myocardial con-
traction band necrosis.
A typical skin lesion of lightning-strike injuries is the “arbo-
rescent” pattern, resembling a fern or tree-like pattern of pink skin
discoloration, representing intravascular hemolysis within subcu-
taneous blood vessels.2 Histologically, it is characterized by in-
tact epidermis and focal blood extravasation in subcutaneous
fat.16 In addition, the lightning strike may also cause carboniza-
tion of skin (more pronounced at entry and exit sites) and epider-
mal necrosis, whereas symmetrical macular marks underneath
breasts are rare.17
Another frequently reported autopsy finding is ruptured tym-
panic membranes, identified in 50% to 80% of the victims.15,18
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Ventura et al
In the event of lightning striking a house, the postulated
mechanism of injury consists in the electrical energy being con-
ducted by way of any type of pipes or wiring.19
The majority of cases of indoor lightning-strike injuries are
related to the use of the telephone.20,21 In such cases, the lightning
incident victim received either an electrical or an acoustic shock
while on the phone. It is not rare for the victim to be “thrown to
the ground” presumably by violent muscle contractions upon the
electric shock. These events almost never cause death because
the individual receives only a fraction of the lightning current or
a low-intensity current.
Bianco-Pampin et al22 describe a case of an indoor lightning
strike, in a 55-year-old man, reached by lightning discharge while
in bed. In this unusual case, investigation of the scene and autopsy
were crucial in establishing the cause of death.
Kreci et al23 report a case of a 46-year-old man who died in-
side his kitchen due to the electrical discharges conducted through
his chimney, whose the external portion was struck by lightning.
A review of the literature confirmed the extreme rarity of the
case proposed. Proper interpretation of the data from autopsy and
histological analysis led to an accurate reconstruction of the events
causing death.
From a post-mortem and medical-legal standpoint there are
different elements which support the conclusions that the death
was caused by the effects of a lightning strike. Carbonization of
the shoes indicated the entry site of electrical discharge to the
body. The lightning strike determined diffuse muscle tetany and
the presence of cutaneous burns of various degrees secondary to
the Joule effect. The low concentration of carboxyhemoglobin in
the blood and the absence of soot in the bronchial tree indicated
that death was abrupt, preceding the onset of the burns. Finally,
epidermal necrosis, with homogenization of the surface dermis
of the right hand showed the passage of current within the skin,
which represented the exit site of the electrical current.
CONCLUSIONS
In summary, investigation of the scene and autopsy findings
proved crucial in determining the cause of death.
The case at hand appears of particular medical-legal interest,
due to the extremely rare circumstances under which the indoor
lightning strike occurred and to the interpretative difficulties dur-
ing investigation of the scene. In fact, the corpse was carbonized in
the absence of evident sources of heat or of flames inside the cot-
tage. The initial hypotheses of the investigators also considered
the possibility that the subject might have been set aflame else-
where, then concealed in the cottage. This notion was later
rejected after careful analysis of the corpse during post-mortem
examinations in relation to the relevant environmental data. Con-
sequently, in addition to the rare nature of this fatality, the case illus-
trated serves as a warning to forensic pathologists. It underscores
that correct interpretation of the data uncovered at the scene of in-
vestigation as well as through autoptic and histological examina-
tions are of the utmost importance for precisely determining
cause and manner of death.
ACKNOWLEDGMENTS
The authors would like to thank F. Portunato and M. Botto
for their assistance in collecting circumstantial data.
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Am J Forensic Med Pathol • Volume 38, Number 1, March 2017
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