Autoerotic death caused by neck compression using a sphygmomanometer cuff: a case report with integrated forensic evaluation.

Autoerotic death, an accidental fatality that occurs during self-stimulatory behavior intended to enhance sexual arousal, poses a diagnostic challenge in distinguishing it from suicide and homicide. Most cases involve neck compression or asphyxial mechanisms, typically through the use of ligatures or suffocation devices. However, reports describing the use of medical devices in an autoerotic context remain limited. We report the case of a man in his 30s who died in his residence after a sphygmomanometer cuff was applied around his neck. He was partially unclothed, and no signs of struggle or third-party involvement were identified. Multiple video recordings stored on a tablet documented repetitive behavior in which the cuff was inflated around the neck during genital stimulation. Autopsy revealed congestion of the head and face, conjunctival and mucosal petechiae, and scattered intramuscular hemorrhagic foci in the tongue, without fractures of the hyoid bone or thyroid cartilage. These findings were compatible with compression produced by an inflatable cuff. Toxicological analyses did not reveal any lethal substances. The cause of death was determined to be asphyxia resulting from neck compression. Although no recording of the fatal event was available, the combined scene findings, digital evidence, and autopsy results supported the conclusion of an accidental autoerotic death. This case highlights the value of integrating scene investigation, digital evidence, and autopsy findings when determining the manner of death in suspected autoerotic fatalities.