Liver failure occurring as a component of exertional heatstroke

Abstract

An unusual case of an exertional heatstroke in a healthy 25-year-old man is presented. Initially, the patient was deeply comatose and developed severe rhabdomyolysis and massive hepatic necrosis. Subsequently, he received a liver transplant with remarkable improvement in his mental status, although the rhabdomyolysis continued. The patient died 41 days after the transplant due to a complicating infection. Providing that infections can be effectively controlled, liver transplants might be a promising therapeutic alternative for the few patients who survive the initial neurological consequences of this unusual event.

Figure 1

A. Total (–) and direct (– –) serum bilirubin, showing decrease following OLTx. B. Serum ALT (– –) and AST (–) both peaked on the first day post-OLTx and decreased thereafter and returned to normal values on the 15th and 19th day, respectively, after OLTx.

Figure 2

A. Liver with dark bands of hepatic necrosis and collapse mimicking cirrhosis (H&E; original magnification ×80). B. Microphotograph of native liver after heatstroke mimicking cirrhosis. However, the darker reddish parenchymal zones, demarcating pseudolobules, are not collagenous but are areas of necrosis and collapse (Masson; original magnification ×5).

Figure 3

A and B. Yellow-greenish. shrunken necrotic muscle of shoulder and upper arm, contrasting to relatively well-preserved red-brown serratus muscles of the chest. C. Diffuse necrosis of peripheral muscle with extensive calcifications, more marked in the left half of the photomicrograph (H&E; original magnification ×80).