Unexpected extrapyramidal symptoms and pulmonary aspergillosis in exertional heatstroke with fulminant liver failure: a case report.
BACKGROUND
Exertional heatstroke is a life-threatening condition with high mortality because of the rapid progress of multiple organ dysfunction syndrome even if aggressive treatments are initiated rapidly. Mild to moderate hepatic injury is common in exertional heatstroke, while fulminant liver failure is rare. Extrapyramidal symptoms and pulmonary aspergillosis secondary to liver failure induced by exertional heatstroke have never been reported in prior cases.


METHODS
A 25-year-old Han Chinese man presented with exertional heatstroke with fulminant liver failure, subsequent pulmonary aspergillosis, and extrapyramidal symptoms. Moreover, he also presented with coma, rhabdomyolysis, acute kidney injury, and disseminated intravascular coagulation. He recovered under conservative treatment including therapeutic plasma exchange plus continuous veno-venous hemofiltration, fluid resuscitation, antibiotics, and other support therapy.


CONCLUSIONS
Therapeutic plasma exchange plus continuous veno-venous hemofiltration could be effective for patients with heatstroke who suffer liver failure and other organ failure. Patients with liver failure are at high risk for pulmonary aspergillosis. Movement disorder in these patients might be extrapyramidal symptoms induced by consistent low level of cholinesterase resulted from hepatic injury besides brain injury.
Critical Care Medicine, Hainan Branch of Chinese PLA General Hospital, Haitangwan District, Sanyan, Hainan Province, 572000, China.
Jie
J
Jiao
Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
Feihu
F
Zhou
Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
Hongjun
H
Kang
Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
Chao
C
Liu
Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
Mengmeng
M
Yang
Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China. hujie0325@foxmail.com.
Jie
J
Hu
D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D000077336:Caspofungin; D003128:Coma / Q000209:etiology; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D054714:Echinocandins / Q000627:therapeutic use; D004569:Electroencephalography; D005440:Fluid Therapy; D018883:Heat Stroke / Q000150:complications*; D006440:Hemofiltration; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000097:blood / Q000209:etiology* / Q000628:therapy; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications*; D010951:Plasma Exchange; D055732:Pulmonary Aspergillosis / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin
Case report; Extrapyramidal symptoms; Heatstroke; Liver failure; Pulmonary aspergillosis; Therapeutic plasma exchange