Drug-induced pulmonary edema and acute respiratory distress syndrome.

Infiltrative lung disease due to noncytotoxic agents

Hydrochlorothiazide-induced pulmonary edema is an unusual but life-threatening adverse reaction. It causes hypoxemia, hypotension, tachycardia, fever, and occasionally electrocardiographic and echocardiographic abnormalities. The mechanism of production is, probably, idiosyncratic.

Recurrent hydrochlorothiazide-induced pulmonary edema.

Hypersensitivity reactions to drugs may cause very rapid physiologic derangements that can be fatal in the absence of adequate compensatory mechanisms or definitive treatment. For the most part, adverse drug reactions that progress over the course of minutes are mediated either by mast cell or complement activation. If a patient survives the acute event, appropriate long-term management requires the identification and future avoidance of the inciting drug. Here, we describe a patient who experienced two life-threatening multisystem reactions with cardiopulmonary compromise minutes after taking hydrochlorothiazide (HCTZ). The reactions were associated with systemic vascular leak resulting in hypotension and non-cardiogenic pulmonary edema.

Hydrochlorothiazide-induced systemic capillary leak.

En Chile, la hidroclorotiazida se utiliza ampliamente como terapia de primera linea en la hipertension arterial esencial. Entre los efectos adversos mas conocidos destacan: trastornos hidroelectroliticos, hiperuricemia, dislipidemia, azotemia, entre otros. El edema pulmonar agudo es un efecto adverso infrecuente y potencialmente grave. Desde 1968, se han reportado 50 casos clinicos en la literatura. En este articulo presentamos el caso clinico de una mujer de 70 anos atendida en el Hospital Santiago Oriente quien, una hora posterior a la ingesta de hidroclorotiazida, presenta disnea aguda progresiva. El estudio clinico y radiologico es compatible con edema pulmonar agudo no cardiogenico.

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Edema pulmonar agudo por hidroclorotiazida: una reacción adversa poco conocida

A 67-year-old man developed non-cardiogenic pulmonary edema after taking a hydrochlorothiazide (HCTZ) tablet. The symptoms remitted following supportive treatment but recurred after rechallenge. Immunologic studies showed increased immunoglobulin E, negative lymphocyte transformation test when exposed to HCTZ, normal blood lymphocyte subpopulations and complement levels, and negative antinuclear antibodies. We reviewed 22 previous reported cases and emphasized that physicians should be aware of this rare but life-threatening reaction.

Shieh Cm

Papers

Hydrochlorothiazide-induced pulmonary edema: a case report and literature review.