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Case Reports
. 2019 Jun 26;7(12):1467-1474.
doi: 10.12998/wjcc.v7.i12.1467.

Fulminant liver failure following a marathon: Five case reports and review of literature

Wojciech Figiel  1 , Marcin Morawski  2 , Michał Grąt  1 , Oskar Kornasiewicz  1 , Grzegorz Niewiński  3 , Joanna Raszeja-Wyszomirska  4 , Maciej Krasnodębski  1 , Arkadiusz Kowalczyk  1 , Wacław Hołówko  1 , Waldemar Patkowski  1 , Krzysztof Zieniewicz  1
Affiliations
Case Reports

Fulminant liver failure following a marathon: Five case reports and review of literature

Wojciech Figiel et al. World J Clin Cases. .

Abstract

Background: The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients; however, fulminant liver failure may occur in approximately 5% of all cases. Liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention.

Case summary: This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertion-induced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion.

Conclusion: Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

Keywords: Case report; Heat Stroke; Hepatic insufficiency; Liver transplantation.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Laboratory findings following the exertion and liver transplantation. A, B: Case 1; C, D: Case 2; E, F: Case 3; G, H: Case 4; I, J: Case 5.
Figure 2
Figure 2
Poor contrast enhancement of liver parenchyma in arterial phase in Case 1.
See this image and copyright information in PMC

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References

    1. Day SM, Thompson PD. Cardiac risks associated with marathon running. Sports Health. 2010;2:301–306. - PMC - PubMed
    1. Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, Joffe AR, Kirpalani HM, Meyer PG, Morris KP, Moher D, Singh RN, Skippen PW Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358:2447–2456. - PubMed
    1. Adams T, Stacey E, Stacey S, Martin D. Exertional heat stroke. Br J Hosp Med (Lond) 2012;73:72–78. - PubMed
    1. Hadad E, Ben-Ari Z, Heled Y, Moran DS, Shani Y, Epstein Y. Liver transplantation in exertional heat stroke: a medical dilemma. Intensive Care Med. 2004;30:1474–1478. - PubMed
    1. Hassanein T, Perper JA, Tepperman L, Starzl TE, Van Thiel DH. Liver failure occurring as a component of exertional heatstroke. Gastroenterology. 1991;100:1442–1447. - PMC - PubMed

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