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Hypercapnia as a Key Mechanism in the Development of Pulmonary Hypertension in Malignant Pertussis: A Case Report

Juan Ignacio Muñoz-Bonet1,2, Francisco José Sebastián-Cuevas1, Eva María Flor-Macián1

  • 1Paediatric Intensive Care Unit Hospital Clínico Universitario Valencia Spain.

Respirology Case Reports
|March 6, 2026
PubMed

Insights

Malignant pertussis (MP) in infants can cause severe pulmonary hypertension (PHT). Controlling hypercapnia, a buildup of carbon dioxide, improved PHT in a severe case, suggesting a modifiable factor in MP management.

Area of Science:

  • Pediatrics
  • Intensive Care Medicine
  • Pulmonology

Background:

  • Malignant pertussis (MP) is a severe complication in infants, often leading to hyperleukocytosis, pulmonary hypertension (PHT), and multiorgan failure.
  • Pulmonary vascular damage is often cited as the cause of irreversible PHT and poor prognosis in MP.
  • This case challenges that notion by demonstrating PHT improvement with CO2 management.

Purpose of the Study:

  • To present a case of malignant pertussis with severe pulmonary hypertension.
  • To investigate the role of hypercapnia in exacerbating PHT during MP.
  • To highlight a potentially modifiable pathophysiological mechanism in MP management.

Main Methods:

  • Case report of a 44-day-old infant with pertussis, hypoxemia, and acute respiratory distress syndrome.
  • Monitoring and management of PHT and hypercapnia.
  • Utilized high-frequency oscillatory ventilation for precise carbon dioxide control.

Main Results:

  • The infant developed severe PHT, which worsened with permissive hypercapnia.
  • Effective carbon dioxide control using high-frequency oscillatory ventilation led to sustained clinical improvement.
  • This suggests PHT in MP may be, in part, a reversible consequence of hypercapnia.

Conclusions:

  • Sustained control of hypercapnia can improve pulmonary hypertension in malignant pertussis.
  • This offers a novel, potentially modifiable therapeutic target for managing MP.
  • Further research is warranted to explore CO2 management strategies in MP.
Keywords:
bronchopneumoniahigh‐frequency oscillatory ventilationhypercapniamalignant pertussispulmonary hypertension

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