Lethal Pertussis with Hyperleukocytosis in an Ethiopian Toddler and Challenges of treatment: A Case Report and Literature Review

Rationale: Pertussis, a highly contagious infectious disease, is a major public health problem even in countries with a high rate of vaccine coverage [1-4]. The mortality and morbidity of pertussis are greater in children, mainly infants aged less than 4 months [5]. Hyperleukocytosis, WBC > 100×109/L, is a rare complication that strongly predicts mortality and morbidity in severe pertussis patients [2–4,6–8]. Hyperhydration, exchange transfusion and hydroxyurea have been used in management trials for hyperleukocytosis caused by fatal pertussis [3,4,6–9]. Patient concerns: Here, we report a case of fatal pertussis in an Ethiopian toddler who initially presented with paroxysmal whooping cough associated with post tussive vomiting, flushing of the face and cyanosis. She had fast breathing, grunting and a low-grade fever. On the third day after hospital admission, she deteriorated and was transferred to the pediatric intensive care unit. Her white blood cell counts on the first day after admission was 137×109 /L, her neutrophil count was 51%, her platelet count was 700×109/L, and her hemoglobin (Hb) level was 14 g/dL. Tests done for hematologic malignancy were not suggestive of malignant/tumor cells, and echocardiography was normal at the time of admission.