Non-Cardiogenic Pulmonary Oedema Provoked by Acetazolamide

A 61-year-old male was brought to the Emergency Department with severe shortness of breath, a throbbing headache, sweating, nausea, vomiting and diarrhoea after the administration of an acetazolamide tablet (250 mg) at a private ophthalmology clinic. On presentation, a chest X-ray was performed, showing diffuse alveolar opacities bilaterally, indicating pulmonary oedema, as seen in CT chest also. However, his echocardiogram revealed a normal ejection fraction with no signs of ischemia. He was subsequently diagnosed with non-cardiogenic pulmonary oedema (NCPE) and was immediately started on high-flow oxygen, later requiring mechanical ventilation. The patient was admitted to the Critical Care Unit with supportive treatment, including IV fluids and antibiotics, without steroid administration. Four days later, he was extubated and subsequently discharged from the ICU, followed by discharge from the hospital. Our case revolves around a rare yet potentially fatal episode of NCPE secondary to Acetazolamide use.