This individual committed suicide with a gun, there was no further info but it looks like he might have used or tried to use two guns, possibly one to the side of the head and the other inside the mouth. Note the bloody cough and numerous tiny blood droplets surrounding the mouth opening.
Cough as a reaction of foreign tracheal content requires intact reflex circles. Sometimes bloody cough results in a very specific blood spreading pattern of small drops more or less surrounding the mouth or distributing along the direction of cough. Substances such as blood trigger the cough reflex, so if for any reason blood accumulates in the airways, it will be ejected this way.
Fig.1
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