Sunstroke with severe liver dysfunction: A case report

We report a case with sunstroke and severe liver damage. A 17-year-old male student was admitted to our hospital because of jaundice on Aug. 1982. His family history and past history were noncontributory. He suddenly lost his consciousness while playing soccer under burning sun on Aug. 23. On admission to another hospital he was soporous with body temperature of 40°C. On Aug. 25, deterioration of liver function was detected and he was transfered to our hospital, while his consciousness became clear. On admission he was icteric and liver was palpable 2 fingerbreadth under the right costal arch. Laboratory data on admission were as follows, GOT 4, 224, GPT 5, 190, CPK 4, 920, LDH 7, 050, total bilirubin 4.5mg/dl and prothrombin time 30%. Urinary myoglobin was positive HBV markers and HA antibody were negative. After admission the patient improved progressively and liver function tests were normalized. Liver biopsy performed 3 weeks after admission revealed preserved lobular archtecture with scattered binuclear cells. Inflammatory cell infiltration was scarcely seen. The mechanism of liver cell dysfunction in patients with sunstroke is not clarified yet, although effects of high body temperature, disturbed hepatic circulation and hypoxia are presumed.