Chronic Mountain Sickness (Cms) Misdiagnosed As High Altitude Cerebral Edema (Hace) At Extreme Altitude (۶۴۰۰ M/۲۱۰۰۰ Ft)

Introduction: Chronic mountain sickness (CMS) represents a syndrome of secondary polycythemia along with thrombocytopenia, altered hemorheology, pulmonary and systemic hypertension, and congestive heart failure, occurring due to hypobaric hypoxia-anoxia-induced erythropoiesis reported in both native mountain residents and new climbers after prolonged stays at high and extreme altitudes.Case Presentation: A healthy non-smoker non-drinker reported occipital headache, breathlessness, and insomnia after an uneventful stay of ۷۰ days at ۶۴۰۰ m/۲۱۰۰۰ ft. His hemoglobin was ۲۱ gm/dL. The patient was diagnosed as having a case of CMS with a Qinghai CMS score >۶. Therapeutic phlebotomy was performed; ۳۵۰ mL was drained on two occasions, reducing his hemoglobin to ۱۴.۶ gm/dL.Conclusion: The altered presentation, difficult diagnosis, evacuation, and long-term management highlighted in this case occurring at ۶۴۰۰ m/۲۱ ۰۰۰ ft in the Karakoram Himalayas represents the insidious nature of altitude sickness in acclimatized subjects.

Keywords:

Chronic mountain sickness , Excessive erythrocytosis , Stress polycythemia , Gaisböck syndrome , Cerebral edema , Extreme altitude , Triple hypoxia syndrome