A 26-year-old male was admitted to the emergency department of our hospital due to loss of consciousness, sinus tachycardia, severe coughing and hyperthermia of 40 oC.
At the time of admission, blood tests showed Hb 14.9 mg/dL, leukocytes 8.660/μL (63% neutrophils, 30.9% lymphocytes), platelets 139,000/μL. The activity of prothrombin was 59%.
The biochemical study highlighted: glucose 169 mg/dL, urea 38 mg/dL, creatinine 2.5 mg/dL, CPK 733 IU/L, Na 135 mmol/L, K 4.2 mmol/L metabolic acidosis: Cl 97 mmol/L.
At 24 hours after admission platelets were 13000/μL. Coagulation times could not be determined due to sample incoagulability.
Creatinine 1.7 mg/dL, CPK 2034 IU/L, total bilirubin 2.3 mg/dL, GOT 883 IU/L, GPT 932 IU/L.
After admission to the Intensive Care Unit, the patient was diagnosed with severe heat stroke, for which she presented complications such as distributive shock, acute renal failure, severe liver failure and disseminated intravascular coagulation.
On the day of admission she presented with frank vomiting, so upper endoscopy was performed.
Endoscopic examination showed arytenoid lesions and Killian's mouth with edematous and congestive appearance, with irregular pigmentation, suggestive of submucosal hematomas.
In the upper third of the esophagus multiple submucosal hematomas of varying sizes were observed, greater than about 20 mm, and petechiae, extending up to the middle third, which did not present lesions.
The lower third showed hematomas similar to those of the upper third, multiple erosions with fibrinous bottom, mucosal edema and carious tear.
The stomach and duodenum were occupied by remnants of esophagus, without mucosal lesions.
Twenty days after the first endoscopy was repeated and the examination was completely normal except for the presence of a small angioma isolated in the gastric antrum.
