BMJ Case Reports 2016; doi:10.1136/bcr-2015-212592

‘Too much of a coincidence’: identical twins with exertional heatstroke in the same race

  1. C Kipps3
  1. 1Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, UK
  2. 2UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Sport, Exercise and Health (ISEH), London, UK
  3. 3Division of Surgery and Interventional Sciences, Institute of Sport, Exercise and Health (ISEH), London, UK
  1. Correspondence to Dr R Smith, ralph.smith{at}
  • Accepted 16 January 2016
  • Published 5 February 2016


This report discusses a unique case of monozygotic male twins who both collapsed with exertional heat stroke (EHS) during the same marathon in relatively cool conditions. The twins were official race pacers in a popular city marathon held in the early spring in the UK. Both recovered uneventfully due to the prompt recognition of EHS and use of aggressive cooling measures, which prevented life-threatening complications. The case illustrates that EHS is a complex illness with a possible genetic predisposition, which can occur among runners even in cooler conditions. This link is explored together with the influence of their role as race pacers and the additional backpack worn in the development of EHS.

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