Bordetella pertussis

Abstract

A 37-year-old woman with a history of inherited dilated cardiomyopathy, which had been successfully treated 20 years ago with a heart transplant, developed restrictive cardiomyopathy and accelerated transplant vasculopathy. She was admitted for an inpatient workup for a new heart transplant. She had a six month history of chronic cough associated with volume overload. On admission she complained of rhinorrhea, sinus congestion, and subjective fever. Four days prior to admission she noted the onset of a cough that was different from her chronic complaint. It felt “deeper” than her usual cough, came in paroxysms, and was occasionally productive of sputum. She reported that the cough was so severe, at times, that she vomited. Her immunosuppression regimen consisted of prednisone and cyclosporine. On physical exam she was found to be afebrile, blood pressure was normal, and scattered crackles were heard throughout both lung fields on auscultation. Noteworthy laboratory test results included a white blood cell count of 6,600 cells/mm³ (normal range, 4,500–11,000 cells/mm³), with a normal distribution of neutrophils, lymphocytes, and mononuclear cells. Microbiologic testing of expectorated sputum showed an adequately collected specimen with heavy mixed upper respiratory flora on gram stain, and the same organisms by culture after two days. A multiplex PCR test for viruses from a nasopharyngeal swab did not detect respiratory syncytial virus, influenza A virus, influenza B virus, parainfluenza types 1/2/3, human metapneumovirus, rhinoviruses, or adenoviruses. Com­puted tomography (CT) of the chest demonstrated a new right upper lobe nodular opacity.