Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Jul 10;17(7):e87648.
doi: 10.7759/cureus.87648. eCollection 2025 Jul.

Is It Time to Consider Hydroxyurea as a Potential Therapeutic Option in the Management of Malignant Pertussis - A Case Report and Literature Review

Abdullah I Alsharif  1 , Yousef DakheelAllah Alatawi  2 , Abeer Mohammed M Alanazi  3
Affiliations
Case Reports

Is It Time to Consider Hydroxyurea as a Potential Therapeutic Option in the Management of Malignant Pertussis - A Case Report and Literature Review

Abdullah I Alsharif et al. Cureus. .

Abstract

Malignant pertussis is a life-threatening condition in infants, for which no effective evidence-based treatment strategies have been established, owing to the rarity of the condition. We present the case of a four-month-old infant with paroxysmal coughing spells followed by a whooping sound and shortness of breath with a leukocyte count of 41.82 × 109/L and lymphocytosis (32.25 × 109/L). A diagnosis of malignant pertussis, based on the severe paroxysmal cough, significant lymphocytosis, and progressive respiratory symptoms, was established, and treatment was initiated with azithromycin and hydroxyurea (20 mg/kg/day) under intensive supportive care. The leukocyte count gradually decreased over five days, and the infant recovered completely after seven days of hospitalization. Notably, the infant did not develop pulmonary hypertension and did not require leukapheresis or any transfusion support during the course of treatment. The case report provides valuable information regarding the presentation of such cases, their diagnosis, and the effectiveness of hydroxyurea as an alternative to whole blood transfusion and leukapheresis. Hydroxyurea is a promising treatment in infants with malignant pertussis and effectively induces a gradual but progressive decline in leukocytosis. Early administration in hemodynamically stable patients may reduce the need for invasive procedures; however, its use in more severe cases requiring urgent leukoreduction may be limited due to the delayed onset of action. This case adds to the limited number of reported instances where hydroxyurea was successfully used as a noninvasive leukoreductive option in malignant pertussis.

Keywords: bordetella pertussis; hydroxyurea; hyperleukocytosis (hl); leukoreduction therapy; malignant pertussis.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. issued approval (IRB) approval was not required at our institution. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Chest radiograph of the infant with malignant pertussis
The image demonstrates diffuse bilateral perihilar infiltrates and hyperinflation.
Figure 2
Figure 2. Change in total leukocytic count during hospital stay
G/L: giga per liter (109 cells/L)
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Pertussis (whooping cough) Decker MD, Edwards KM. J Infect Dis. 2021;224:0–20. - PMC - PubMed
    1. An update of the global burden of pertussis in children younger than 5 years: a modelling study. Yeung KHT, Duclos P, Nelson EA, Hutubessy RC. Lancet Infect Dis. 2017;17:974–980. - PubMed
    1. Modifying antibiotic treatment strategies in the face of pertussis surge associated to erythromycin resistance in China. Shi W, Meng Q, Hu Y, Yao K. J Infect. 2024;88:106174. - PubMed
    1. Identifying children at risk of malignant Bordetella pertussis infection. Ganeshalingham A, McSharry B, Anderson B, Grant C, Beca J. Pediatr Crit Care Med. 2017;18:0–7. - PubMed
    1. Malignant pertussis in infants: factors associated with mortality in a multicenter cohort study. Coquaz-Garoudet M, Ploin D, Pouyau R, et al. Ann Intensive Care. 2021;11:70. - PMC - PubMed

Publication types

LinkOut - more resources