title: Extreme heatstroke causing fulminant hepatic failure requiring liver transplantation: a case report.
abstract: BACKGROUND
  Exertional heatstroke with liver involvement is a rare and potentially fatal condition. In this setting, fulminant hepatic failure (FHF) occurs as a result of severe hypoxic hepatitis.
  
  
  METHODS
  We report the case of a young male athlete who developed exertional heatstroke associated with rhabdomyolysis and hypoxic hepatitis while running the final stages of an ultra-marathon (62 km). The patient rapidly developed multiorgan failure, including fulminant hepatic failure, requiring intensive care admission for mechanical ventilation, hemodialysis, and inotropic support. He failed to improve with supportive measures and underwent an emergency hepatectomy followed by orthotopic liver transplant, after which he recovered completely.
  
  
  CONCLUSIONS
  We discuss the rationale for liver transplantation in this setting, possible alternative treatments, and the pathophysiology of fulminant liver failure in this rare case.
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: H M
authors.initials: HM
authors.lastname: Heneghan
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Nazirawan
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Dorcaratto
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Fiore
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: J F
authors.initials: JF
authors.lastname: Boylan
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Maguire
authors.affiliation: Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland. Electronic address: emirhoti@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Hoti
mesh_terms: D000328:Adult; D018883:Heat Stroke / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D012206:Rhabdomyolysis / Q000209:etiology