Ketamine is a nonbarbiturate anaesthetic that provides good analgesia with only moderate amnestic and hypnotic effects. Ketamine at low anaesthetic dosages produces a trance-like state with alterations in mood, cognition, and body image. There are only a few papers in the literature that report deaths by acute ketamine poisoning. The case reported here involved a homicide caused by chronic poisoning with ketamine perpetrated by a husband against his 34-year-old wife. In the autopsy, the determination of ketamine concentrations was achieved with gas-chromatography/mass spectrometry. The most striking forensic findings were cardiac muscle fibrosis and hyaline degeneration of the small arteries of the victim's heart, which are pathological features of ketamine poison previously reported only in animal studies. The husband's fingerprints were found on the surface of empty ketamine glass vials collected by investigators from the garbage can, as well as on the coffee cup used by his wife shortly before she collapsed. After being detained by the police as a suspect, the husband confessed that he had been using ketamine to poison his wife. His motive was to be free to marry his lover without the expense of a divorce settlement. The husband was a pediatric surgeon with easy access to ketamine and with a knowledge of its toxicity. 2 figures and 12 references