To report a case of previously undocumented mononeuritis multiplex secondary to cold-water immersion in the setting of exertional heat stroke management.

Exertional heat stroke (EHS) is the most severe form of heat illness and is especially prevalent among military members. The standard of care is cold water immersion (CWI) based on the current guidelines developed and implemented by both military and civilian institutions. This poster addresses the presentation, management, and outcomes of a United States Air Force Special Warfare trainee who experienced persistent cold-induced neuropathy as a result of CWI for treatment of EHS as well as a brief literature review. 

Case Report

A previously healthy 33-year-old male developed an elevated core body temperature while performing military training.  He was diagnosed with EHS and received guideline-directed CWI. He required prolonged immersion to correct his elevated body temperature in the setting of acute agitation and required sedation. He experienced multiple well-described sequelae of EHS that were resolved following his stabilization as well as new onset numbness, pain, and tingling in bilateral lower extremities. Electromyogram/nerve conduction study confirmed the etiology as mononeuritis multiplex. The patient’s mononeuritis multiplex persisted for over one year, refractory to multiple lines of therapy. 

Cold-induced neuropathy is shown by this case to be a possible sequalae of CWI for treatment of EHS, which results in significant individual morbidity. However, the risk of mortality without rapid cooling in the setting of exertional heat stroke outweighs the risk of this adverse event. Further research into the optimal duration of CWI, guidelines for supplemental sedation, and effective treatment modalities for cold-induced neuropathy are recommended to help guide acute and chronic management.