Kellie Snooks, DO
Medical College of Wisconsin
Milwaukee, Wisconsin
Disclosure information not submitted.
Katie McDermott, APRN, BSN, MSN, RN
Critical Care Pediatric Nurse Practitioner
Childrens Hospital of Wisconsin
Milwaukee, Wisconsin
Disclosure information not submitted.
Binod Balakrishnan, MD
Assistant Professor of Pediatrics
Medical College of Wisconsin
Milwaukee, Wisconsin
Disclosure information not submitted.
Sheila Hanson, MD, MS
Professor of Pediatrics
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Disclosure information not submitted.
Title: But What if There Is No Cough?
Case Report Body:
Introduction: Pertussis encephalopathy is a rare complication occurring in less than 1% of patients with an acute pertussis infection.
Description: A previously healthy 4-month-old presented to the pediatric intensive care unit with acute encephalopathy, as well as profound metabolic lactic acidosis, hypertonia, and focal neurological findings. She progressed to clinical and subclinical status epilepticus confirmed by electroencephalogram (EEG). Due to persistent fevers, a comprehensive infectious evaluation was completed yielding a positive nasopharyngeal polymerase chain reaction (PCR) swab isolating Bordetella pertussis bacterium. On presentation, she had the absence of typical pertussis symptoms such as apnea and cough. Brain magnetic resonance imaging (MRI) findings were relatively nonspecific and progressed over the span of five hospital days from initially unremarkable, later to areas of restricted diffusion indicative of postictal cerebral edema, and finally to axonal edema. Ultimately, she was diagnosed with acute pertussis encephalopathy.
Discussion: A deficiency of recent investigation and literature regarding pertussis encephalopathy, especially in children, is a limiting factor to health care professionals considering it as a potential etiology of acute encephalopathy in children. A complete lack of typical pertussis symptoms and a recent administration of her routine infant immunizations were additional complicating factors in this case. It is important to consider unique presentations of uncommon diagnoses both when initial evaluation results are not diagnostic and when clinical course progression is not an expected trajectory.