Simultaneous death of twins: an environmental hazard or SIDS?

The sudden and simultaneous death of twin infants is described. The search for hazards in the home and the postmortem investigation provided an insight into the possible mechanism of death. Instead of a diagnosis of simultaneous sudden infant death syndrome (SIDS), the infants were determined to be victims of a combination of several environmental factors that led suddenly to death. Strong circumstancial evidence of nonnatural (accidental) death included sublethal levels of carbon monoxide (CO), overwrapping, and mechanical obstruction of upper airways. The literature concerning the phenomenon of simultaneous twin death is also reviewed.