Noncardiogenic pulmonary edema associated with hydrochlorothiazide therapy

We describe a patient with the sudden onset of pulmonary edema on two separate occasions immediately after the ingestion of hydrochlorothiazide. Although this adverse reaction to hydrochlorothiazide has been reported previously in six patients, the cause of the pulmonary sensitivity remains obscure. A noncardiogenic etiology has been suggested, but prior cases have failed to document cardiopulmonary hemodynamic measurements. A Swan-Ganz balloon flotation catheter demonstrated cardiopulmonary pressures in our patient consistent with a noncardiac origin of the pulmonary edema.