Abstract
First described by Carlos M. Monge in 1925, chronic mountain sickness (CMS), also known as Monge's disease, is the inability of usual acclimation to life at high altitudes in indigenous or long-term high altitude dwellers above 3000 m.
Diagnostic criteria for CMS still remains controversial; however, patients will exhibit a form of erythrocytosis and a myriad of clinical symptoms, which may include headache, mental confusion, altered mental status, fatigue, anorexia, cyanosis, shortness of breath, palpitation, tinnitus, dizziness, sleep disturbances, and/or dilatation of veins. These various symptoms and polycythemia generally will resolve at lower altitudes.
We report a case of CMS seen in Andahuaylillas, a small village outside of Cusco (3360 m), in the Peruvian Andes. A 55-year-old male farmer presented to our medical clinic during a 2-week project with a local nongovernmental organization (NGO). The patient's symptoms and laboratory data confirmed the diagnosis.
Treatment of CMS in patients living in the Peruvian Andes may be impeded by several obstacles. Currently, relocating to lower altitudes or periodic therapeutic phlebotomy are the mainstays of therapy. These interventions pose a financial burden for the majority of patients and may contribute to poor treatment adherence. However, recent research suggests that the medication, acetazolamide, which is used primarily for the prevention of acute mountain sickness, can be helpful in cases of CMS.
The diagnosis and treatment of CMS is challenging in the remote Peruvian Andes. Education of physicians and other medical providers working in high-altitude regions requires a high index of suspicion for appropriate diagnosis and care.