An unusual case of an exertional heatstroke in a healthy 25-year-old man is presented. Initially, the patient was deeply comatose and developed severe rhabdomyolysis and massive hepatic necrosis. Subsequently, he received a liver transplant with remarkable improvement in his mental status, although the rhabdomyolysis continued. The patient died 41 days after the transplant due to a complicating infection. Providing that infections can be effectively controlled, liver transplants might be a promising therapeutic alternative for the few patients who survive the initial neurological consequences of this unusual event.An outbreak of heatstroke occurred among 50 police trainees who were participating in an intense recruitment training program in Massachusetts in 1988. Each experienced a variable degree of exercise-induced rhabdomyolysis. Forty of the trainees (80%) reported dark urine, 26 (52%) experienced myoglobinuria and hemoglobinemia, and 13 (26%) experienced kidney damage secondary to rhabdomyolysis. One recruit experienced hepatic failure and went into deep coma. This individual and his clinical course is the topic of this report. Case ReportA previously healthy 25-year-old white man without a history of alcohol or drug use, who had been on a diet to lose weight and who had been exercising vigorously for several hours in a deconditioned state, suddenly collapsed during supervised exercise. He was admitted to a local hospital in Massachusetts, unconscious, unresponsive to deep pain, hypotensive (70/0), hyperthermic (105°F rectal), tachypneic (60/min), and with tachycardia (128/min).He experienced seizures which were treated with diazepam and phenytoin. Thereafter, he rapidly developed multisystem organ failure manifested as disseminated intra-vascular coagulation (DIC), liver and renal failure, and rhabdomyolysis. Because of combined renal and hepatic failure, he was transferred to the Presbyterian University Hospital in Pittsburgh on his sixth day after heatstroke for possible liver and kidney transplantation. On admission to the intensive care unit in Pittsburgh, he was comatose (grimaced to pain), had a rectal temperature of 38.6°C, blood pressure of 110/70, heart rate of 124, and respiratory rate of 22. His pupils were minimally reactive; gag and corneal reflexes were present but reduced; and his neck was supple. His limbs were flaccid with reduced muscle tone; deep tendon reflexes were present. His sclera were icteric. His abdomen was distended slightly but without organomegaly and ascites. Bowel sounds were reduced. Rectal examination revealed stool that was guaiacpositive. The rest of his examination was unremarkable. He was anuric (50 mL/day). The little urine that was collected contained 100-300 red blood cells per high-power field, 0-2 white Address requests for reprints to:

An unusual case of an exertional heatstroke in a healthy 25-year-old man is presented. Initially, the patient was deeply comatose and developed severe rhabdomyolysis and massive hepatic necrosis. Subsequently, he received a liver transplant with remarkable improvement in his mental status, although the rhabdomyolysis continued. The patient died 41 days after the transplant due to a complicating infection. Providing that infections can be effectively controlled, liver transplants might be a promising therapeutic alternative for the few patients who survive the initial neurological consequences of this unusual event.A n outbreak of heatstroke occurred among 50 police trainees who were participating in an intense recruitment training program in Massachusetts in 1988. Each experienced a variable degree of exercise-induced rhabdomyolysis. Forty of the trainees (80%) reported dark urine, 26 (52%) experienced myoglobinuria and hemoglobinemia, and 13 (26%) experienced kidney damage secondary to rhabdomyolysis. One recruit experienced hepatic failure and went into deep coma. This individual and his clinical course is the topic ofthis report. Case ReportA previously healthy 25-year-old white man without a history of alcohol or drug use, who had been on a diet to lose weight and who had been exercising vigorously for several hours in a deconditioned state, suddenly collapsed during supervised exercise. He was admitted to a local hospital in Massachusetts, unconscious, unresponsive to deep pain, hypotensive (70/0), hyperthermic (105°F rectal), tachypneic (60/minJ, and with tachycardia (12B/min).He experienced seizures which were treated with diazepam and phenytoin. Thereafter, he rapidly developed multisystem organ failure manifested as disseminated intravascular coagulation (DIC), liver and renal failure, and rhabdomyolysis. Because of combined renal and hepatic failure, he was transferred to the Presbyterian University Hospital in Pittsburgh on his sixth day after heatstroke for possible liver and kidney transplantation. On admission to the intensive care unit in Pittsburgh, he was comatose (grimaced to pain), had a rectal temperature of 3B.6°C, blood pressure of 110/70, heart rate of 124, and respiratory rate of 22. His pupils were minimally reactive; gag and corneal reflexes were present but reduced; and his neck was supple. His limbs were flaccid with reduced muscle tone; deep tendon reflexes were present. His sclera were icteric. His abdomen was distended slightly but without organomegaly and ascites. Bowel sounds were reduced. Rectal examination revealed stool that was guaiac-positive. The rest of his examination was unremarkable. He was anuric (50 mL/day). The little urine that was collected contained 100-300 red blood cells per high-power field, 0-2 white blood cells per high-power field, and was myoglobin-positive. The other laboratory data obtained on admission are shown in Table 1. A hepatitis profile for hepatitis B virus and delta virus were negative whereas the hepatitis A virus screen was positive for immun...