The authors report the case of a 76 year-old woman affected by heatstroke complicated by massive liver cell necrosis and fulminant liver failure, with a favorable outcome. Liver cell necrosis was localized in centro- and medio-lobular areas and was not associated with hepatic vein congestion. These histological features suggest that the main causal factor of liver cell necrosis was relative liver cell hypoxia secondary to increased oxygen tissular requirements induced by hyperthermia.