Letaler Verlauf eines Hitzeschocks nach körperlicher Anstrengung bei starker Sonneneinstrahlung

Heat stroke is a lifethreatening disease with high mortality, characterized by a body temperature of over 40°C and clinical symptoms of central nervous system dysfunction. However, the pathophysiological mechanisms are not fully understood. A new interesting explanation for the clinical symptoms could be a systemic inflammatory response due to barrier dysfunction in the intestine leading to endothelial damage and a syndrome of multiorgan dysfunction. We describe a 37-year-old male patient who collapsed while working in a vineyard in an environmental temperature of 32°C with a body temperature of 42.5°C. Despite intensive care treatment, he died with symptoms of shock and multiorgan dysfunction. Autopsy was performed followed by the histological evaluation of paraffin-embedded tissue. As correlates for clinical shock symptoms, shock kidneys and shock liver could be demonstrated. Furthermore, multiple microthrombi were found, together with clinically undetectable fibrinogen values. Finally, the patient died due to massive diffuse gastrointestinal bleeding and bleeding in pleural and pericardial cavities. No signs of severe edema of the central nervous system were detectable. This case supports the hypothesis that in heat stroke endothelial damage occurs with consecutive cascade of inflammatory and coagulatory reactions, which may play a critical pathophysiological role.