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

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.