High Altitude Pulmonary Edema (HAPE)

By Gustavo Zubieta Sr, MD, Gustavo Zubieta Jr, MD and Luis Zubieta, M.D.


High Altitude Pulmonary Edema (HAPE) is an acute illness with dramatic manifestations in the lung, that also affects all systems of the body. Hence, very careful observations are required to discover all of these manifestations. It is our observation that patients with HAPE frequently have ulcers on the tongue. The tongue appears white with one or more reddish colored ulcers that have rough irregular borders. It is non painful, and without bleeding. The alterations of the mucosa of the tongue appear similar to geographic tongue. It seems to be related to the severity of the HAPE, and disappears rapidly with oxygen treatment of the pulmonary edema. These alterations are also present in other affections, but in persons who go to high altitude it may help in making a fast and early diagnosis. The origin of the ulcers is unknown, although it has been hypothesized to be a manifestation of viral infection, associated to peripheral vasoconstriction, and/or dehydration.

Fig. 1. Photograph of the tongue showing ulcers in a patient with HAPE. Fig. 2. Chest X-ray of a patient with HAPE.

@Copyright 1/24/96 IPPA - La Paz, Bolivia

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