Case 2

A man aged 61 years admitted to our hospital with a 5-year history of chronic lymphocytic leukemia and a matched, unrelated donor stem cell transplantation 12 days prior complained of a 1-day history of nonproductive cough, sore throat, and fatigue. He denied fever, chills, shortness of breath, hemoptysis, nausea, vomiting, ill contacts, and recent travel.

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His vital signs were all within normal limits. Finding on physical examination was remarkable for coarse breath sounds heard across the left lung fields. His white blood cell count was 560 μL, absolute neutrophil count was 190 μL, and lymphocyte count was 200 μL. The patient was receiving pneumocystis prophylaxis and tested negative for P jiroveci.

The result from a nasopharyngeal swab sent for a respiratory viral PCR panel was positive for B pertussis. PCR testing was negative for adenovirus, C pneumoniae, coronavirus, metapneumovirus, rhinovirus, enterovirus, influenza types A and B, Mycoplasma, parainfluenza virus types 1 to 4, and respiratory syncytial virus. Radiography of his chest showed an interval increase in opacification of the perihilar lungs. CT of his chest demonstrated patchy, bilateral airspace disease and ground-glass nodularity, which was greatest in the left lower lobe and bilateral small pleural effusions (Figure 2). Rapid strep testing was negative, and blood cultures did not show any growth after 3 days.

He was treated with a 7-day course of oral azithromycin (250 mg daily) and was followed-up in the clinic. He reported complete resolution of his symptoms 2 weeks later. Repeat PCR testing for B pertussis performed on day 26 was negative.