The Fire from Within: Multiorgan Failure with Bimodal Rhabdomyolysis from Exertional Heat Stroke

Area of Science:

• Sports Medicine
• Hepatology
• Critical Care Medicine

Background:

• Exertional heat stroke (EHS) can lead to acute liver failure (ALF), a rare but life-threatening complication.
• Prognostic criteria for liver transplantation in EHS-induced ALF are challenging to apply, with limited literature available.
• Extracorporeal liver support is emerging as a bridge therapy for liver failure.

Observation:

• A young Filipino athlete presented with clinical features of EHS and subsequent multiorgan failure.
• The patient developed bimodal rhabdomyolysis, indicated by a distinct rise in creatine kinase levels.
• Initial consideration for liver transplantation and plasma exchange was made due to the severity of liver injury.

Findings:

• The patient demonstrated significant clinical improvement with conservative supportive management alone.
• Liver transplantation and total plasma exchange were ultimately not required.
• The case underscores the potential for recovery with intensive supportive care in EHS-induced ALF.

Implications:

• This case suggests that aggressive supportive management may be sufficient for select patients with EHS-induced ALF.
• It highlights the need for careful patient selection and consideration of non-transplant options.
• Further research is warranted to refine prognostic criteria and management strategies for EHS-induced ALF.