Autoerotic deaths occur in the context of sexual activity when different devices and objects are used to increase stimulation and sexual pleasure, resulting in unintentional deaths. A common feature of autoerotic deaths s the presence of a self-rescue mechanism to ensure survival and escape a dangerous situation. By definition, autoerotic deaths are accidental. Thus, it is essential to exclude suicide or homicide. An atypical case of autoerotic asphyxia is presented, in which the victim showed a ligature mark produced by a soft belt with maximum pressure on the posterior aspect of the neck and the point of suspension located anteriorly. A detailed scene investigation and the autopsy findings helped determine the manner of death. Determining the manner of death in AADs can be challenging and has a significant legal, social, and economic impact. A multidisciplinary approach is required to reach the correct conclusion. We present a case of AAD with atypical findings.
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