Severe Acute Liver Injury Related to Heat Stroke

Fani Ribeiro; Mário Bibi; Marta Pereira; Sofia Ferreira; Helena Pessegueiro; Rui Araújo

doi:10.12890/2020_001382

Severe Acute Liver Injury Related to Heat Stroke

Eur J Case Rep Intern Med. 2020 Jan 1;7(2):001382. doi: 10.12890/2020_001382. eCollection 2020.

Authors

Fani Ribeiro¹, Mário Bibi², Marta Pereira³, Sofia Ferreira⁴, Helena Pessegueiro⁴, Rui Araújo³

Affiliations

¹ Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Portugal.
² Department of Internal Medicine, Unidade Local de Saúde de Matosinhos, Portugal.
³ Intensive Care Department, Unidade de Saúde Local de Matosinhos, Portugal.
⁴ Hepatic and Pancreatic Transplantation Unit, Centro Hospitalar do Porto, Portugal.

Abstract

Heat stroke (HS) is a life-threatening condition characterized by hyperthermia and multiple organ failure. Mild to moderate hepatocellular injury is a well-documented complication but severe liver injury and acute liver failure are rare. There are neither established criteria nor optimal timing for liver transplantation and conservative management seems to be the cornerstone treatment. The authors report a case of a patient with severe liver injury related to HS who recovered completely under conservative treatment.

Learning points: Hyperthermia, neurologic dysfunction and recent exposure to hot weather or physical exertion should raise the suspicion of heat stroke (HS).Fast and effective cooling is the cornerstone of treatment, along with support of organ dysfunction. Antipyretics have no role in HS management.Conservative treatment has been described as being successful in the management of patients with HS that manifest severe acute liver injury (ALI) and acute liver failure (ALF). However, early referral to a liver transplantation centre is essential to guide treatment.

Keywords: Heat stroke; acute liver injury; liver transplantation.