• Cheng Wooi Yeoh and Wan Chung Law.
• Department of Medicine, Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohammad Musa, Kota Samarahan, Sarawak, Malaysia.
• Medicine (Baltimore). 2023 Dec 22; 102 (51): e36676e36676.

RationaleHeat-related illnesses have protean manifestations that can mimic other life-threatening conditions. The diagnosis of heat stroke requires a high index of suspicion if the patient has been exposed to a high-temperature environment. Central nervous system dysfunction is a cardinal feature. Strict adherence to temperature criteria can potentially lead to misdiagnosis.Patient ConcernsA 37-year-old construction worker was brought in by his wife and coworker due to a sudden loss of consciousness while resting after completing his work.DiagnosesDue to challenges faced during the coronavirus disease 2019 pandemic, as well as language barriers, a detailed history from the coworker who witnessed the patient's altered sensorium was not available. He was initially suspected of having encephalitis and brainstem stroke. However, subsequent investigations revealed multiorgan dysfunction with a normal brain computed tomography and cerebral computed tomography angiogram. In view of the multiple risk factors for heat stroke, pupillary constriction, and urine color suggestive of rhabdomyolysis, a diagnosis of heat stroke was made.InterventionsDespite delayed diagnosis, the patient's multiorgan dysfunction recovered within days with basic supportive care.OutcomesThere were no noticeable complications on follow-up 14 months later.LessonsHeat stroke can be easily confused with other neurological pathologies, particularly if no history can be obtained from the patient or informant. When approaching a comatose patient, we propose that serum creatinine kinase should be considered as an initial biochemical screening test.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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