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Non-Exertional Heatstroke: A Case Report and Review of the Literature

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis), Rare co-existance of disease or pathology

Chiara Mozzini, Giovanni Xotta, Ulisse Garbin, Anna Maria Fratta Pasini, Luciano Cominacini

Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy

Am J Case Rep 2017; 18:1058-1065

DOI: 10.12659/AJCR.905701

Available online:

Published: 2017-10-04

BACKGROUND: Heatstroke (HS) is a life-threatening condition characterized by an elevation of the core body temperature above 40°C, central nervous system dysfunction, and possible multi-organ failure. HS can trigger systemic inflammation, disseminated intravascular coagulation (DIC), rhabdomyolysis, cerebral edema and seizures, pulmonary edema, heart dysfunctions, and renal and hepatic failure.
CASE REPORT: We report the case of a 41-year-old Romanian woman with a history of alcoholism who developed HS after arriving by bus in Verona, Italy in June 2016. The patient developed consecutive multi-organ dysfunction, including liver and renal failure, rhabdomyolysis, DIC, and arrhythmia. The patient was successfully treated with conservative measures. After 17 days, she recovered completely.
CONCLUSIONS: The exact mechanism of HS-related multiple organ dysfunction is not completely understood and its pathogenesis is complex. It involves inflammation, oxidative stress, endoplasmic reticulum (ER) stress, and mitochondrial dysfunction. Development of a model in which chronic alcohol abuse alters oxidative, inflammatory, and ER stress response could also be a conceivable solution to the positive prognosis of severe HS patients, in which liver failure has a prominent role.

Keywords: Disseminated Intravascular Coagulation, drug-induced liver injury, Heat Stroke