Exertional Heat Stroke in a Young Man with Multi-organ Dysfunction and Fulminant Pneumonia

Choi,  Wook Jin; Lee,  Jae Wook; Lee,  Se Won

J Korean Soc Emerg Med > Volume 20(4); 2009 > Article

Case Report

Journal of The Korean Society of Emergency Medicine 2009;20(4): 458-462.

Exertional Heat Stroke in a Young Man with Multi-organ Dysfunction and Fulminant Pneumonia

¹Department of Emergency Medicine, The Armed Forced Capital Hospital, Korea. koreanermd@gmail.com
²Department of Internal Medicine-Nephrology, The Armed Forced Capital Hospital, Korea.
³Department of Internal Medicine-Pulmonology, The Armed Forced Capital Hospital, Korea.

ABSTRACT

Heat stroke is defined as a core body temperature that rises above 40 degrees C accompanied by central nervous system abnormalities such delirium, convulsions or coma. Despite treatment with optimal cooling, heat stroke causes deaths by complications including rhabdomyolysis, renal failure, hepatic dysfunction, disseminated intravascular coagulation syndrome, acute respiratory distress syndrome, bowel ischemia, myocardial injury, and multiple organ failure. In some cases of survival, heat stroke it can cause irreversible CNS damage. Therefore, if exertional heat stroke is properly diagnosed in the emergency room, we must initiate early and aggressive treatment in order to prevent the multiorgan failure and high mortality associated with this condition. To our knowledge, case reports in the literature are rare describing that patients with multiple organ dysfunction and fulminant pneumonia following exertional heat stroke. This study reports on a relevant case, as well as findingsfrom the literature. The case history is presented of a 20- year-old man who presented with exertional heat stroke with sustained hyperpyrexia ongoing after the first day of admission despite optimal treatment including intensive fluid resuscitation. On the 3rd day of admission, chest infiltrated lesions were discovered. From the high-resolution computed tomography results, multifocal consolidations were discovered in both lungs. Blood cultures revealed Staphylococcus hominis. Treatment with proper antibiotics was begun after identifying the blood culture. The patient fully recovered and was discharged on the 10th day after admission.

Key words: Heat stroke, Heat stress disorder, Pneumonia, Rhabdomyolysis, Staphylococcus hominis