Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 42 45 EN Masoud Mohammadpour Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Bahare Yaghmaie Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Meysam Sharifzadeh Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Behdad Gharib Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Noohi Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 04 2017 08 21 Pertussis incidence is increasing worldwide especially in infants < 2 months old with high mortality rate. Fulminant pertussis is characterized by refractory hypoxemia, cardiogenic shock, pneumonia, and intense leukocytosis that certainly needs intensive care and can lead to 75% mortality rate. Leukoreduction measures especially exchange transfusion (ET) have been used with some successful outcomes. We report ET as a treatment in a case of malignant pertussis with multi-organ failure syndrome. A 57-day-old infant who was admitted in pediatric intensive care unit with severe paroxysmal cough and extreme leukocytosis that despite appropriate treatment and full supportive care progressed to seizure, renal failure, pulmonary hypertension, and shock state, but his condition improved after ET. The patient was discharged from our hospital in good condition. ET even in the presence of multi-organ failure may be lifesaving and should be considered. https://crcp.tums.ac.ir/index.php/crcp/article/view/117 https://crcp.tums.ac.ir/index.php/crcp/article/download/117/75