A 72-year-old woman was found dead in her bedroom in her apartment in Padua, Italy. She was found face down on the floor next to the blood-drenched bed. A single stab wound through her abdomen had punctured her liver. The stained knife was found in the top drawer of the nightstand. Her pants were around her knees, and both legs were jammed in one pantleg. Abrasions were found on her head, her left arm and right leg. A bloody trail in the hallway connected blood stains in the kitchen and in the bathroom, where there was also a pile of her bloody clothes.

That blood trail ultimately connected the dots for the Italian investigators—it showed several minutes of the deceased attempting to cover up the scene of a self-inflicted stabbing, as described in the Journal of Forensic Sciences.

“In forensic practice, differentiating between suicide and homicide may be difficult (…because a multitude of unusual suicides have been reported in the forensic literature,” write the investigators, from the University-Hospital of Padova.

The woman’s wound was a single 4-centimeter vertical stab wound made with the 21-centimeter knife. Heavy-flow drip patterns were found in the kitchen. The hallways showed a trail pattern, which showed some wiping.

A vest with a hole and unstained underpants were found in the hallway right outside the bathroom. Inside the bathroom were a pair of blood-drenched pants, and contact blood transfers on the top of the toilet seat and the edge of the bathtub, according to the investigators.

The cause of death was exsanguination, according to the autopsy.

The investigation turned up the fact that the woman had been suffering from major depression since the suicide of her son three years earlier, the paper adds.

No signs of forced entry or struggle were found in the apartment, and there were no extraneous fingerprints or footprints noted at the scene.

The death reconstruction was based mostly off the blood the woman left behind in the last minutes of her life.

The passive drip pattern showed that the woman stabbed herself with the knife, depositing a large volume of liquid blood straight down to the floor.

The blood drips showed she next went into the bedroom, where she left the knife and the sweater with the knife hole in it.

She went to the bathroom, dropping the rest of the blood-soaked clothing and the unmarked underpants.

She then walked back to the bedroom, dragging her feet through the blood she had already left on the ground.

She sat down on the bed, where her blood soaked through the sheets and mattress. But during her attempts to put a new set of clothes on, she lost consciousness and eventually bled out.

“This reconstruction of events also explains the blunt force traumas found on the body, probably because of the unsteady gait of the victim after stabbing herself, who hit the wall and/or furniture of the house (left arm and right leg) and the floor in the final low-levels fall (head),” they write.

What remains unclear is whether the woman simply wanted to hide her suicide—or whether she inflicted the wound, had second thoughts, and was attempting to get dressed before seeking help, they add.

Sharp-force suicides represent between 1 and 3 percent of all self-inflicted deaths. But the latest case study shows how difficult they can prove for investigators, the Italian authorities write.

“If on one hand, the ‘disguised suicide’ has been a widely discussed matter in forensic literature, sharp force suicides disguised by the victim as a homicide are uncommon,” they add. “In fact, after self-stabbing, the victim voluntarily altered the death scene, making the differentiation between suicide and homicide even more complex to investigators.”