Exertional heat stroke (EHS) is a clinical syndrome of hyperthermia, encephalopathy and multi-organ dysfunction that can be irreversible and fatal. Prompt recognition and immediate, aggressive total body cooling can prevent progression of the clinical syndrome, but even a short delay can exacerbate the effects of hyperthermic-induced changes. EHS is linked to an inflammatory response that is akin to the systemic inflammatory response syndrome (SIRS). However, because EHS is not a common problem in most hospital intensive care units and is not in the usual list of SIRS causes, it may easily be overlooked. The present case report will highlight the preliminary clinical manifestations of the syndrome, the initial optimal treatment, and its clinical sequelae.