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Abstract

hemopericardium and cardiac tamponade should be suspected in subjects with a history of percutaneous closure of an ASD who present with acute chest pain or shortness of breath and signs of hemodynamic instability.Case Report: The incidence of Bordetella pertussis has been increasing recently, with a marked rise noted in 2012, with 48,000 cases reported by the CDC that year. The jump is attributed to resistance to vaccination as well as lack of public awareness of booster immunizations. While the disease carries significant morbidity in children, its course is typically mild in adults. At our facility, we admitted a 33-year-old female with history of mild intermittent asthma who works in a day care center. She reported a 6-day history of upper respiratory symptoms. She had been compliant with albuterol, Medrol dosepack, and amoxicillin prescribed by her primary care, with minor improvement in symptoms. In the ER, she was found be in impending respiratory failure, with tachypnea, stridor, and pulse oxygen saturation of 84% on non-rebreather mask. Emergent intubation was performed using a glidoscope and bougie with a 6.0 endotracheal tube. Following stabilization of the airway, a CT of the neck showed edematous infra and supraglottic airway encompassing the ETT. Laboratory data revealed lactic acidosis and bandemia. The patient was given intramuscular epinephrine and started on azithromycin, ceftriaxone, and steroids. Workup for hereditary angioedema, blood and sputum cultures, and viral multiplex PCR were negative. On day 3 of hospitalization, the patient had a positive cuff-leak test; the next day, she was taken to the operating room for extubation, which was well tolerated. She was discharged on hospital day 6 on prednisone taper. Following discharge, serology for pertussis showed elevated IgA at 52 (normal range <50), consistent with acute pertussis. This case reinforces the importance to deliver booster vaccination in all adults. In our case, our patient had underlying reactive airway disease and was frequently exposed to sick children, some of whom may not have completed their vaccination series due to age. Although pertussis rarely causes disease in adults, our patient nearly died due to severe laryngeal edema.