Exertional heat stroke with multiorgan dysfunction in a community sports event: case report and one-month follow-up

Exertional heat stroke (EHS) is a life-threatening emergency characterized by central nervous system (CNS) dysfunction with hyperthermia and frequent multiorgan injury. Although outcomes have improved with rapid on-site cooling in elite sports and military contexts, data from community sporting events in low- and middle-income countries (LMICs) remain scarce. We report a 30-year-old previously healthy Vietnamese male who collapsed during a 5-km community run. He presented with encephalopathy, generalized seizure, metabolic acidosis, acute kidney injury (AKI) (creatinine 149 µmol/L, estimated glomerular filtration rate (eGFR) 53), rhabdomyolysis (creatine kinase (CK) 3745 U/L), and myocardial injury (high-sensitivity troponin I (hs-troponin I) peak 3.87 ng/mL). The electrocardiogram (ECG) showed incomplete right bundle branch block with minor ectopy, while echocardiography revealed preserved systolic function. With rapid cooling and supportive care, renal, muscular, and cardiac abnormalities resolved. At one-month follow-up, hs-troponin I and CK had normalized (0.0016 ng/mL; 155 U/L), creatinine was 81 µmol/L, and ECG was normal, confirming full clinical recovery. This case illustrates EHS with multiorgan dysfunction successfully managed at a community sporting event in Vietnam. The comprehensive one-month biomarker and cardiac follow-up highlights the potential for full recovery, while emphasizing the need for cost-effective emergency preparedness-including trained staff and rapid cooling strategies-in LMIC community events.