SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Pulmonary Edema Secondary to Hydrochlorothiazide Use

Pdf Summary

This document summarizes a rare case of hydrochlorothiazide (HCTZ)-induced noncardiogenic pulmonary edema (NCPE) in a 73-year-old man. After being switched from losartan to losartan-HCTZ for hypertension, he developed acute weakness, nausea, vomiting, diarrhea, fever, and shortness of breath about 2.5 hours after taking the medication. He appeared ill, was hypoxic and tachypneic, and had bilateral crackles. Imaging showed bilateral interstitial opacities and lung ultrasound demonstrated B-lines, but cardiac evaluation was reassuring: normal BNP, troponin, and left ventricular function, making cardiogenic edema unlikely.<br /><br />Laboratory findings included marked leukopenia without eosinophilia and a very high procalcitonin, which initially raised concern for infection, so he was treated for presumed community-acquired pneumonia. However, his symptoms resolved rapidly within about 5 hours, and he was discharged the next day. At follow-up, he had no recurrence after stopping HCTZ.<br /><br />The report emphasizes that HCTZ-induced NCPE is rare but potentially life-threatening. Symptoms usually begin within minutes to hours of ingestion, can occur on first exposure or with intermittent use, and commonly include dyspnea, wheezing, cough, fever, chills, and gastrointestinal symptoms. Classic allergic features such as urticaria, flushing, or eosinophilia are typically absent. The mechanism is unclear but may involve an idiosyncratic, neutrophil-mediated pulmonary injury. Severe cases may require ventilatory support, vasopressors, or even ECMO.<br /><br />Management is immediate discontinuation of HCTZ and supportive care. Rechallenge is not recommended because of the risk of severe recurrence. The authors advise counseling patients to avoid thiazide diuretics indefinitely after such a reaction.

Asset Subtitle

Evan J. Chen

Meta Tag

Author List Evan J. Chen, Katherine Frishe, Laurie Hayrapetian

Category Clinical Vignettes

Concept Hydrochlorothiazide-Induced Noncardiogenic Pulmonary Edema

Concept Hydrochlorothiazide Discontinuation

Concept Adverse Drug Reaction

Concept Drug Rechallenge

Concept Respiratory Failure

Distinguished Non-Finalist

Presenter Organization USC/Los Angeles General Medical Center

Presenting Author Evan J. Chen

Track Adult

Keywords

hydrochlorothiazide

noncardiogenic pulmonary edema

HCTZ-induced reaction

losartan-HCTZ

acute dyspnea

bilateral interstitial opacities

procalcitonin elevation

leukopenia

thiazide diuretics

drug-induced pulmonary injury

Hydrochlorothiazide-Induced Noncardiogenic Pulmonary Edema

Hydrochlorothiazide Discontinuation

Adverse Drug Reaction

Drug Rechallenge

Respiratory Failure