Clinical Features and Autopsy Findings in Fulminant Hepatic Failure by Exertional Heat Stroke: Case Report

A healthy 48 year-old man became unconscious suddenly, with a corporal temperature of 43ºC when participating in a strenuous motorcycle off-road competition in the last 2 days in southeastern Brazil on a very hot and humid summer. Once the first 6 hours of in-hospital he had dysfunction of several organ and systems. During the following days, he developed fulminant hepatic failure (FHF), disseminated intravascular coagulation, rhabdomyolysis and multiple organ failure. Despite the use of immediate conventional core body temperature control methods and support of organ-system function, the patient died on 11th day. Autopsy findings: there was significant jaundice impregnation, petechial and hemorrhagic suffusions in the skin and in visceral organs as well as generalized edema. The microscopic exam showed cytotoxic and vasogenic brain edema and encephalic death. The liver and the pancreas were diffusely necrotic and hemorrhagic, besides rhabdomyolysis, cardiac failure and acute tubular necrosis in the kidneys. The immunohistochemistry exam showed diffuse liberation in the lung and other viscera tissue of tumor necrosis factor-α (TNFα). In spite of being a rare occurrence, FHF should be included in the complications induced by exertion and commonly progresses to death.