Lower Respiratory Tract Infection: An Unrecognised Risk Factor for High Altitude Pulmonary Edema?

  • Christopher Paul Humphries Norfolk and Norwich University Hospitals, Norwich
Keywords: High Altitude Pulmonary Edema, Oedema, Infection, Respiratory, Risk, Expedition


The case of a 25-year-old expedition doctor who developed high altitude pulmonary oedema (HAPE) while climbing in the Swiss Alps is presented, with reference to the literature. The patient’s symptoms of HAPE were typical. Less typical was the fact that the doctor had previously been to similar altitudes uneventfully. The only differentiator is that on this expedition he developed a mild lower respiratory tract infection (LRTI) 2 days prior to travel. There has been limited, conflicting evidence regarding LRTI as a risk factor for HAPE and high quality research has not focused on this area. LRTI is not commonly recognised as being a risk in high altitude environments, which may be resulting in lethal consequences. This report aims to inform, provide a clinical question for future high altitude research expeditions, and encourage consideration by expedition and high altitude doctors.


  • Zhou Q. Changes of pulmonary vasoactive factors and its relation with pulmonary arterial hypertension in patients with high altitude pulmonary edema. Cardiovasc Res 2014;103:557–594.

  • Luks AM. Physiology in medicine: a physiologic approach to prevention and treatment of acute high-altitude illnesses. J Appl Physiol 2015;118:509–519.

  • Shoene RB, Swenson ER. High-altitude pulmonary edema. In: Swenson ER, Bartsch P, editors. High altitude: human adaptation to hypoxia. New York: Springer; 2014, pp. 405–427.

  • Scherrer U, Rexhaj E, Jayet PY, Allemann Y, Sartori C. New insights in the pathogenesis of high-altitude pulmonary edema. Prog Cardiovasc Dis 2010;52:485–492.

  • Hacket PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness.Lancet 1976;308:1149–1155.

  • Murdoch DR. Symptoms of infection and altitude illness among hikers in the Mount Everest region of Nepal. Aviat Space Environ Med 1995;66:148–151.

  • West JB, Schoene RB, Luks AM, Milledge JS. In: West JB, Schoene RB, Luks AM, Milledge JS, editors. High altitude medicine and physiology. Boca Raton, FL: CRC Press; 2013, p. 315–316.

  • Shaible B, Schaffer K, Taylor CT. Hypoxia, innate immunity and infection in the lung. Respir Physiol Neurobiol 2010;174:235–243.

  • Luks AM, Swenson ER. Travel to high altitude with pre-existing lung disease. Eur Respir J 2007;29:770–792.

  • The Lake Louise Consensus on the Definition and Quantification of Altitude Illness. In: Sutton JR, Coates G, Houston CS, editors. Hypoxia and mountain medicine. Burlington, VT: Queen City Printers; 1992.

  • Oelz O, Ritter M, Jenni R, et al. Nifedipine for high altitude pulmonary oedema. Lancet 1989;334:1241–1244.

  • Heller I, Halevy J, Cohen S, Theodor E. Significant metabolic acidosis induced by acetazolamide. Not a rare complication. Arch Intern Med 1985;145:1815–1817.

  • Wrenn KD, Slovis CM, Minion GE, Rutkowski R. The syndrome of alcoholic ketoacidosis. Am J Med 1991;91:119–128.

  • Fukao T, Mitchell G, Sass JO, Hori T, Orii K, Aoyama Y. Ketone body metabolism and its defects. J Inherit Metab Dis 2014;37:541–551.

  • Chakko S, Woska D, Martinez H, et al. Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med 1991;90:353–359.

  • Labrousse J, Tenaillon A, Massabie P, Simonneau G, Lissac J. Effect of artificial ventilation on pulmonary capillary pressure in acute respiratory insufficiency. Nouv Presse Med 1977;6:1639–1642.

  • Maggiorini M, Melot C, Pierre S, et al. High-altitude pulmonary edema is initially caused by an increase in capillary pressure. Circulation 2001;103:2078–2083.

  • Hultgren HN. High-altitude pulmonary edema: current concepts. Annu Rev Med 1996;47:267–284.

  • Dickstein K, Cohen-Solal A, Filippatos G, et al. European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2008;29:2388–2422.

  • Preston IR. Clinical perspective of hypoxia-mediated pulmonary hypertension. Antioxid Redox Signal 2007;9:711–721.
  • Published: 2017-04-27

    Issue: Vol 4 No 3 (view)

    Section: Articles

    How to cite:
    Humphries, C. (2017). Lower Respiratory Tract Infection: An Unrecognised Risk Factor for High Altitude Pulmonary Edema?. European Journal of Case Reports in Internal Medicine, 4(3). https://doi.org/https://doi.org/10.12890/2017_000539