Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1467-1474
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1467
Fulminant liver failure following a marathon: Five case reports and review of literature
Wojciech Figiel, Marcin Morawski, Michał Grąt, Oskar Kornasiewicz, Grzegorz Niewiński, Joanna Raszeja-Wyszomirska, Maciej Krasnodębski, Arkadiusz Kowalczyk, Wacław Hołówko, Waldemar Patkowski, Krzysztof Zieniewicz
Wojciech Figiel, Marcin Morawski, Michał Grąt, Oskar Kornasiewicz, Maciej Krasnodębski, Arkadiusz Kowalczyk, Wacław Hołówko, Waldemar Patkowski, Krzysztof Zieniewicz, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw 02097, Poland
Grzegorz Niewiński, Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw 02097, Poland
Joanna Raszeja-Wyszomirska, Liver and Internal Medicine Unit, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw 02097, Poland
Author contributions: Figiel W, Morawski M designed the study concept; Figiel W, Morawski M, Grąt M, Kornasiewicz O, Niewiński G, Raszeja-Wyszomirska J, Krasnodębski M, Kowalczyk A, Hołówko W, Patkowski W collected the data; Figiel W, Morawski M, Zieniewicz K analyzed the data; Figiel W, Morawski M wrote the draft of the article; all authors critically revised the manuscript; Zieniewicz K supervised the study.
Supported by the Foundation for Polish Science (FNP) with START stipend, No. START 032.2018.
Informed consent statement: Informed consent statement was obtained from the reported patients.
Conflict-of-interest statement: The authors deny any conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcin Morawski, MD, Doctor, PhD student, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, ul. Banacha 1A, Warsaw 02097, Poland. marcin.morawski@wum.edu.pl
Telephone: +48-22-5992545 Fax: +48-22-5991545
Received: March 3, 2019
Peer-review started: March 4, 2019
First decision: April 18, 2019
Revised: April 29, 2019
Accepted: May 1, 2019
Article in press: May 2, 2019
Published online: June 26, 2019
Processing time: 115 Days and 16.7 Hours
Abstract
BACKGROUND

The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients; however, fulminant liver failure may occur in approximately 5% of all cases. Liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention.

CASE SUMMARY

This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertion-induced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion.

CONCLUSION

Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

Keywords: Heat Stroke; Hepatic insufficiency; Liver transplantation; Case report

Core tip: Patients with exertion-induced heat stroke may develop fulminant liver failure and may recover with conservative treatment alone or require liver transplantation. To date, there is a lack of definitive criteria to identify patients who could potentially benefit from a surgical vs. a conservative approach. This study discusses a series of 5 cases in which the following 3 distinct clinical outcomes were observed in patients: spontaneous recovery, the need for liver transplantation, and death following exertion-induced liver failure.