High-Altitude Pulmonary Edema in Ohio at an Elevation of 339 Meters

BACKGROUND: HAPE (High-Altitude Pulmonary Edema) is a life-threatening form of high-altitude illness caused by noncardiogenic pulmonary edema. It has been most commonly reported in individuals who live at lower elevations and travel to elevations above 2500 m, typically in those who do so without any acclimatization. It can also occur in residents of high altitudes who descend to lower altitudes and then return to their native altitude without acclimatization. HAPE is more common in individuals with a history of prior HAPE, very rapid rates of ascent, upper respiratory illness, extreme exertion and cold environmental temperatures, Down’s Syndrome, obesity and congenital pulmonary anomalies. CASE PRESENTATION: Our case discusses a patient presenting to an emergency department in Ohio with severe respiratory distress, hypoxia and a radiograph that showed pulmonary edema without cardiomegaly. Additional history revealed the patient had recently returned from Breckenridge, Colorado (an elevation of approximately 2926 m). The diagnosis of HAPE was recognized and he was appropriately treated. He was educated and will not be returning to high altitude without acclimatization in the future. CONCLUSION: Upon literature review, there has never been a prior documented case of a patient in Ohio with HAPE. Providers must consider altitude illness when evaluating travelers from high altitude destinations, even when traveling to a very low altitude like Ohio, as symptoms may be unresolved by descent alone. This case emphasizes the importance of obtaining relevant historical data including a travel history. It also emphasizes the importance of avoiding early closure of the diagnostic process by only considering common conditions. Finally, the case emphasizes the potential danger of anchoring bias to previously encountered conditions.