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Hydrochlorothiazide-Induced Noncardiogenic Pulmonary Edema: BAL Fluid Analysis

Omar S. Darwish, MS, DO; Jasminka Criley, MD
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From the Department of Medical Education, St. Mary Medical Center, Long Beach, CA.

Correspondence to: Omar S. Darwish, MS, DO, Department of Medical Education, St. Mary Medical Center, 1050 Linden Ave, Long Beach, CA 90813; email: odarwish@medicity.biz


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):193-194. doi:10.1378/chest.10-0944
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Hydrochlorothiazide (HCTZ)-induced pulmonary disease has been described as either an allergic interstitial pneumonitis or a cause of noncardiogenic pulmonary edema. The mechanism of this rare life-threatening side effect is largely unknown. Many patients show peripheral leukopenia and extensive immunologic studies reveal decreased levels of serum immunoglobulins. However, evaluation of the peripheral blood may not reflect local lung changes. Literature reports of bronchoalveolar differentials on such patients are scarce. Bronchoscopy was performed on our patient, and the lavage revealed a significant percentage of neutrophils (70%) and no eosinophils.

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