A Case of Spontaneous Bacterial Peritonitis Caused by Heatstroke

Abstract

A 64-year-old man suffered from heatstroke in a sauna. At the time of admission, he was unconscious, hyperthermic and had an unstable hemodynamics status. We diagnosed the patient as having hypovolemic shock due to heatstroke and treated him with intravenous cold normal saline infusion and cooling blankets. On day 2, laboratory tests revealed liver failure and rhabdomyolysis. On day 3, his condition deteriorated further. Abnormal ultrasonography showed evidence of fluid collection, while abdominal computed tomography showed ascites in the pelvic cavity, with scattered thickening of the walls of the small and large intestine, which appeared more pronounced than on the day of admission. On day 4, he had bloody diarrhea and worsening lactic acidosis. We suspected intestinal necrosis, and performed immediate exploratory laparotomy. There was no obvious intestinal necrosis. We drained the contaminated ascites, and the patient gradually stabilized and recovered from the heatstroke after surgery. Bacterial cultures of both blood and ascitic fluid specimens grew Escherichia coli, and based on the clinical course of the patient, we considered that the heatstroke had caused spontaneous bacterial peritonitis. The patient was discharged on day 31. It appears that peritonitis can develop as a complication of heatstroke.