Juan Ignacio Muñoz-Bonet, Francisco José Sebastián-Cuevas, Eva María Flor-Macián, María del Carmen Ortega-Sánchez, Andrés Rodríguez-Sacristán, Juan Brines
Hospital Clínico Universitario. University of Valencia. Hospital Dr. Peset Valencia. Hospital Universitario Virgen Macarena.
Spain
Respirology Case Reports
Respirol Case Rep 2026; 14:
DOI: 10.1002/rcr2.70528
Abstract
Malignant pertussis (MP) is a highly lethal complication of pertussis in young infants, typically associated with hyperleukocytosis, pulmonary hypertension (PHT), and multiorgan failure. Some authors suggest that structural pulmonary vascular damage explains the irreversibility and poor prognosis. In contrast, we present a well-documented case where sustained control of hypercapnia improved PHT. This case prompted a literature review. A 44-day-old male infant was admitted to our paediatric intensive care unit with confirmed pertussis and severe hypoxaemia. He required immediate intubation. The clinical course progressed to severe acute respiratory distress syndrome with PHT. Permissive hypercapnia was observed to worsen PHT, requiring progressive escalation of ventilatory and haemodynamic support. The use of a high-powered high-frequency oscillatory ventilator enabled effective carbon dioxide control and sustained clinical improvement. This case offers a novel perspective on a potentially modifiable pathophysiological mechanism in the management of MP.
Category
Class I. Pulmonary Hypertension Associated with Infection
Medical Therapy. Efficacy or Lack of Efficacy
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes