Exchange Transfusion in Management of Fulminant Pertussis: A Case Report

Pertussis incidence is increasing worldwide especially in infants 2 months old with high mortality rate. Fulminant pertussis is characterized by refractory hypoxemia, cardiogenic shock, pneumonia, and intense leukocytosis that certainly needs intensive care and can lead to 75% mortality rate. Leukoreduction measures especially exchange transfusion (ET) have been used with some successful outcomes. We report ET as a treatment in a case of malignant pertussis with multi-organ failure syndrome. A 57-day-old infant who was admitted in pediatric intensive care unit with severe paroxysmal cough and extreme leukocytosis that despite appropriate treatment and full supportive care progressed to seizure, renal failure, pulmonary hypertension, and shock state, but his condition improved after ET. The patient was discharged from our hospital in good condition. ET even in the presence of multi-organ failure may be lifesaving and should be considered.