Two simultaneous cases of exertional heat stroke during a trail run in Guadeloupe (French West Indies): exceptional presentations or emerging trend?

BACKGROUND: Exertional heat stroke is a potentially fatal condition that can affect individuals performing intensive physical activity, particularly in hot environments. We report two simultaneous cases of EHS that occurred during the same outdoor sporting event in Guadeloupe (French West Indies) in April, in two unrelated young athletes with similar profiles but different clinical pictures. At the time of the event, the apparent temperature was 29.6 °C with a relative humidity of 85%. CASES PRESENTATION: Patient 1: A 22-year-old man with no known medical history collapsed during an endurance test after running for one hour and 40 minutes. Pre-hospital medical care was immediately initiated and the onsite clinical assessment revealed deep coma and major hyperthermia (41.7°C). The patient was rehydrated, cooled using ice packs, and intubated onsite before being medically transferred to an intensive care unit. On admission, he presented with multi-organ dysfunction syndrome affecting neurological, hemodynamic, renal, and hepatic functions. Intensive care management included external cooling, vasopressor support with noradrenaline, extrarenal purification, antibiotic therapy and continuous administration of N-acetylcysteine. After more than 16 days in intensive care, the patient was discharged home without sequelae. Patient 2: A 19-year-old man with no known medical history collapsed in the same morning, at almost the same time, during that endurance test after running for one hour and 35 minutes. Unlike the first case, no pre-hospital medical care was provided. The patient was evacuated to an emergency department. On admission, clinical examination revealed confusion and hyperthermia (39.2°C). Blood tests revealed rhabdomyolysis associated with acute renal failure yet was treated with intravenous fluid therapy. He eventually recovered and was discharged on the same day. CONCLUSIONS: The tropical climate is an extrinsic risk factor for exertional heat stroke, which can lead to diverse clinical presentations of varying severity when combined with other factors such as intrinsic factors. This risk is likely to increase in future years given the current context of global warming. Prevention, recognition, and rapid management of this medical emergency, mainly by external cooling, particularly in tropical environments, is paramount.