Page 96 - JSOM Spring 2026

High-Altitude Pulmonary Edema Management

in a Special Operator

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Jafet Ojeda Rodriguez, MD *; David Shumway, DO ; Priscilla Tubbs, DO ;
Madelaine Leek, DO ; Darrell Nettlow, MD 5
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ABSTRACT
This case report delves into the challenges in diagnosis and often the sole means of evaluation, heightening the importance
management of a 30-year-old Army Special Forces officer who of mastering signs and symptoms to identify HAPE. 3
experienced respiratory distress during high-altitude training
in Nepal, where he gained 3,000m in elevation over 3 days. Patients exposed to hypobaric hypoxia typically present within
Notably, the patient was prophylactically treated with acet- the first days of ascent with a non-productive cough and ex-
azolamide but did not receive nifedipine or tadalafil. At an ertional dyspnea. As the condition progresses, weakness,
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elevation of 13,550 feet (4,130m), the patient developed clas- fatigue, cyanosis, tachypnea, tachycardia, and nocturnal ex-
sic high-altitude pulmonary edema (HAPE) symptoms as well acerbation of symptoms become evident. This is sometimes
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as concomitant respiratory symptomatology of breathlessness accompanied by a fever, occasionally reaching up to 101.3°F,
and worsening productive cough. The complexity of this case akin to an infectious etiology. Importantly, HAPE tends to
lay in managing HAPE in a remote, resource-limited environ- manifest above 2,500m, and its etiology is rooted in the body’s
ment with a small rescue window. We analyze the treatment struggle to regulate fluid within the alveoli. Hypoxia, com-
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alternatives used and ones not used, such as the portable hy- mon at higher altitudes, triggers pulmonary hypertension and
perbaric chamber, and emphasize the necessity for standard- increased pulmonary vascular permeability, exacerbating the
ized HAPE prophylaxis in appropriate personnel to prevent accumulation of fluid. 5,6
disruption to mission and loss of operational capabilities.
For military missions conducted at high altitudes, prevention,
Keywords: high-altitude pulmonary edema (HAPE); rapid diagnosis and intervention can be mission-sustaining
pararescuemen; rapid ascent; military operations; altitude- and even life-saving. In this case report, we highlight the case
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related illnesses; austere environment; remote environments; of an Army Special Forces member who experienced symp-
wilderness medicine; mountain medicine toms of HAPE with a narrow rescue window, underscoring the
challenges and complexities encountered while treating this
condition during military operations in remote high-altitude
settings. Additionally, we review the indications for prophy-
Introduction
laxis, the benefits of reducing operational impact from these
High-altitude environments present an array of distinctive conditions, and areas in which to improve future operations
challenges and potential threats, particularly for individuals and existing protocols.
engaged in arduous activities at elevated altitudes in austere
environments. In recent years, high-altitude pulmonary edema Case Presentation
(HAPE) has gained recognition as a leading cause of respi-
ratory deterioration among individuals subjected to rapid al- A 30-year-old male Army Special Forces officer with no sig-
titude gains. In the past, it was frequently misdiagnosed as nificant past medical history presented with worsening pro-
community-acquired pneumonia, largely due to a limited un- ductive cough, fatigue, shortness of breath, nasal congestion,
derstanding of its pathogenesis and pathophysiology. In the frontal headaches, chills, and blurry/hazy vision for 48 hours.
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hospital setting, diagnostic criteria include X-ray, electrocar- Multiple prior operations and training exercises had been ac-
diogram, and echocardiographic data to confirm the diagnosis complished by this individual at similar altitudes without in-
and exclude other etiologies. In austere wilderness settings cidences of acute mountain illness or pulmonary symptoms.
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where diagnostic resources are scarce, clinical assessments are The patient had undergone significant altitude gain during a
*Correspondence to jafet.a.ojedarodriguez.mil@health.mil
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1 Dr. Jafet Ojeda Rodriguez and Dr. David Shumway are affiliated with Internal Medicine, Keesler Medical Center, Biloxi, MS. Dr. Priscilla Tubbs
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is affiliated with the College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN. Dr. Madelaine Leek is affiliated with the
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School of Osteopathic Medicine, A.T. Still University, Kirksville, MO. Dr. Darrell Nettlow is affiliated with Pulmonary/Critical Care, Keesler
Medical Center, Biloxi, MS.
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