Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Abstract

Hydrochlorothiazide has been shown to cause rare, but serious non-cardiogenic pulmonary edema. We present a case report of a patient with apparent septic shock and acute respiratory distress syndrome (ARDS) requiring life-sustaining veno-venous extracorporeal membrane oxygenation (VV-ECMO). Upon further review of the literature and the chronology of the patient's presentation, her condition was most likely due to an immune-mediated reaction to hydrochlorothiazide. This represents the first case, to our knowledge, of such a severe reaction to hydrochlorothiazide supported with ECMO therapy.

Noncardiogenic pulmonary edema in small animals

“…It is suspected that the sulfur groups increase pulmonary vascular permeability, potentially via immunoglobulin G deposition in the lung. [110][111][112] Similarly, protamine seems to cause NCPE in an immunoglobulin G-mediated manner. 113 NCPE secondary to nonionic low-osmolar-radiocontrast material may be due to viscosity-induced erythrocyte damage, leading to capillary stasis and fluid extravasation.…”

“…Thoracic radiographs in people with drug-induced NCPE may show bilateral or unilateral alveolar edema with air bronchograms, ranging from mild to complete opacification of all lung fields. b, [109][110][111]115,119 The distribution can be perihilar or diffuse. 112,117,119,120 The 1 dog with cytarabine-associated pulmonary edema showed a multilobar patchy alveolar pattern.…”

“…27 Thoracic CT findings in humans with drug-related NCPE have been described as diffuse, bilateral alveolar and interstitial infiltrates. 111,114 No reports on CT findings in dogs or cats are available.…”

“…Acetazolamide and hydrochlorothiazide are both diuretics containing sulfur groups and both compounds have been implicated in causing NCPE. It is suspected that the sulfur groups increase pulmonary vascular permeability, potentially via immunoglobulin G deposition in the lung 110–112 . Similarly, protamine seems to cause NCPE in an immunoglobulin G‐mediated manner 113 .…”

“…Additionally, in many drug reactions complications other than pulmonary edema may contribute to the prognosis. b, 11,27,29,108–120 However, most reported cases in people seem to have a favorable outcome with short hospitalization times. b, 109–115,117,119,120 …”