Images in Clinical Medicine
Whooping Cough in an Adult
N Engl J Med 2012; 366:e39June 21, 2012DOI: 10.1056/NEJMicm1111819
A 64-year-old man was admitted to the medical service with a presumed asthma exacerbation. His symptoms had worsened during the preceding 3 weeks despite treatment with oral glucocorticoids, leading him to present to the emergency department multiple times with a progressive cough. He also reporting having associated chest tightness and difficulty eating and sleeping, without any post-tussive emesis. Shortly after his admission, the medical team heard a characteristic “whooping” cough (see video). He was given azithromycin, and samples were obtained for serologic testing and for nasopharyngeal culture of Bordetella pertussis. The patient's cough abated and his respiratory status improved during the next 5 days. Approximately 1 week after discharge, test results were returned that were positive for B. pertussis. Further questioning revealed that the patient had never been vaccinated against pertussis. He received a tetanus–diphtheria–acellular pertussis (Tdap) vaccine approximately 1 month after discharge.
Renee K. Rutledge, M.D.
Erica C. Keen, M.D., Ph.D.
Newton–Wellesley Hospital, Newton, MA
This article (10.1056/NEJMicm1111819) was updated on September 27, 2012, at NEJM.org.