title: [Malignant pertussis and exchange transfusion].
abstract: METHODS
  Malignant pertussis is a critical clinical state associated with fatal outcome in 70% of cases. The severity criteria are a lung infection with pulmonary hypertension and hyperleukocytosis usually above 50 G/L. We report the case of a 2.5-month-old girl hospitalized with critical pertussis in a pediatric intensive care unit. She had acute respiratory distress syndrome with pulmonary hypertension complicated by a bacterial secondary infection with Enterobacter cloacae managed by high-frequency oscillatory ventilation associated with pulmonary vasodilatation therapy. In the absence of clinical improvement and before considering extracorporeal life support, exchange transfusion was performed at day 9 to reduce hyperleukocytosis at 70 G/L. Exchange transfusion was successfully performed with a reduction of leukocytes to under 40 G/L followed by steady improvement of pulmonary function. Weaning from mechanical ventilation and discharge took place at day 23 and 38, respectively.
  
  
  CONCLUSIONS
  Exchange transfusion should be considered in infants suffering from malignant pertussis with extreme leukocytosis before hemodynamic failure to improve the survival prognosis.
authors.affiliation: Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France. Electronic address: j.chantreuil@chu-tours.fr.
authors.forename: J
authors.initials: J
authors.lastname: Chantreuil
authors.affiliation: Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France; Faculté de médecine de Tours, université François-Rabelais, 37000 Tours, France.
authors.forename: N
authors.initials: N
authors.lastname: Fakhri
authors.affiliation: Médecine pédiatrique, hôpital Clocheville, CHRU de Tours, 37000 Tours, France; Inserm U1069, faculté de médecine de Tours, université François-Rabelais, 37000 Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Labarthe
authors.affiliation: Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France; Inserm U930, faculté de médecine de Tours, université François-Rabelais, 37000 Tours, France.
authors.forename: E
authors.initials: E
authors.lastname: Saliba
authors.affiliation: Réanimation pédiatrique et néonatologie, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France; Inserm U930, faculté de médecine de Tours, université François-Rabelais, 37000 Tours, France.
authors.forename: G
authors.initials: G
authors.lastname: Favrais
mesh_terms: D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000209:etiology / Q000628:therapy*; D014917:Whooping Cough / Q000150:complications / Q000628:therapy*