A 27-year-old was rescued twice in four days from near the summit of Mount Fuji after developing symptoms of altitude illness on both occasions. The patient was first evacuated by helicopter on April 22, 2025, after becoming symptomatic near the summit (3776 meters). In a startling turn, he reattempted the climb on April 26 to retrieve his mobile phone and was rescued again after again falling ill. This subsequent emergency required a team of rescuers to carry him down 800 meters on a stretcher until handing him off to an emergency medical team. This real-world case highlights the need for clinicians to reinforce post-AMS guidance, particularly regarding rest, recovery, and safe return-to-altitude protocols. It also underscores the perception gap among hikers who may view “non-technical” climbs like Fuji as low risk despite their physiological demands.
Mount Fuji, Honshu Island, Japan, Photo by Casia Charlie
Altitude illness, including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), occurs when individuals ascend above 2500 meters without adequate acclimatization. Mount Fuji’s summit presents a significant risk, especially outside the July–September climbing season when conditions are colder, medical facilities along the trail are closed, and rescue options are limited.
The initial symptom of nausea reported in this case was consistent with AMS, prompting the airlift from the mountain's peak. Upon the second climb attempt, another hiker found the patient “shaking with abrasions” and unable to move. This suggests inadequate recovery and possible progression to HACE.
According to the Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis and Treatment of Acute Altitude Illness: 2024 Update, preparation for a climb like Mount Fuji can depend on the individual’s health and risk profile. Across the board, gradual ascent is key, with emphasis on gradually increasing sleeping altitude, limiting increases to 500 meters/day above 3000 meters. Pharmacological prophylactic measures, like acetazolamide, should be considered to mitigate the risk of altitude sickness. Ibuprofen, although not the preferred measure, can also be used, considering its accessibility and lower risk of allergy.
In any case of moderate-to-severe altitude illness (determined by the Lake Louise Score), immediate descent is the primary intervention, especially if the patient is not responding to pharmacologic therapy (acetazolamide for AMS and dexamethasone for HACE) or if this type of treatment is unavailable. As with AMS and HACE, descent is the priority when treating cases of HAPE; supplemental oxygen should also be employed. Pharmacologic therapy, such as nifedipine, should be used if descent is delayed. Portable hyperbaric therapy is also an effective temporizing measure in remote settings, though challenging to maintain or transport. Gradual ascent is the number one way to prevent AMS, HACE, and HAPE development and should be stressed to patients anticipating such a climb.
Physicians should educate patients that the resolution of subjective symptoms does not guarantee physiologic recovery. Literature and expert consensus suggest that in cases of HAPE, a minimum of 7-10 days at a low altitude is advised to ensure full alveolar and vascular recovery. With HACE, due to neuroinflammation and risk of recurrence, patients should remain at a low altitude for at least two weeks, with attention to neurocognitive rest and reassessment before re-exposure. Additionally, a conservative ascent profile should follow any moderate-to-severe altitude illness. Prophylactic acetazolamide (125 mg BID) is recommended for those with prior illness, rapid ascent profiles, or limited acclimatization opportunity. Based on these guidelines, one can see that the Mount Fuji patient risked his health considerably by going back for his second ascent so soon. This case is a prime example of emphasizing the importance of post-event counseling.
Upon the second rescue of the patient from Mount Fuji, there was an uproar on social media that there is a need for serious consequences for those who ignore wilderness safety guidelines, however, through the lens of the medical community, this case more so highlights the need for targeted public education on non-technical high-altitude peaks, strict return-to-altitude criteria, and clinician-driven reinforcement of recovery protocols. A primary message should be that premature re-exposure can result in repeat illness or increased morbidity.
If patients, particularly individuals at risk, are counseled early, many instances of AMS, HACE, and HAPE can be avoided. Furthermore, firm recommendations regarding rest duration and re-acclimatization protocols are critical for those already affected. Patients like the one from this case should understand that they are risking their lives by disregarding such directives. Had the Mount Fuji hiker not been found and rescued so quickly, this case could have taken a sharp turn for the worse.