Icy Hot: A Case of Unexpected Heat Illness

Finish-line collapse is a unique phenomenon among athletes and includes a broad working differential. We explore the case of a young, healthy runner who collapsed at the end of a half marathon in the fall from exertional heat illness. This illness covers a wide range of severity from the mild symptoms of heat cramps to heat exhaustion and the extreme of life-threatening heat stroke. Development of these conditions is often associated with patient-specific acquired or congenital vulnerability factors such as extremes of age, fitness, obesity, medication use (eg, antipsychotics, anticholinergics, and amphetamines), or chronic disease. Environmental factors such as high humidity and heat are commonly implicated. Our case explores the possible impact of a recent viral illness on temperature regulation and the development of exertional heat illness in an otherwise well-trained athlete.