Inam Danish Khan - Clinical Microbiology, Army College of Medical Sciences and Base Hospital, Delhi Cantt ۱۱۰۰۱۰, India

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.

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