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A previously healthy 10-year-old boy was brought to the pediatric emergency department with a 4-day history of progressive bruising of the eyelids. Four weeks before presentation, a dry cough had developed and increased in intensity over the previous week. The patient was up to date on routine vaccinations and had no history of trauma or coagulopathy. Physical examination was notable for ecchymoses on the eyelids and subconjunctival hemorrhage in both eyes (Panels A, B, and C). A complete ophthalmologic examination was otherwise normal. One day before presentation, the patient’s pediatrician had used a polymerase-chain-reaction assay to test a nasopharyngeal swab specimen for Bordetella pertussis, and the result was positive. A diagnosis of eyelid ecchymoses and subconjunctival hemorrhages owing to pertussis was made. In pertussis (also known as whooping cough), small blood vessels in and around the eyes may rupture when venous pressures increase as a result of intense paroxysms of coughing. Other complications of severe coughing include rib fracture, pneumothorax, and syncope. Treatment with clarithromycin was given. At the 4-week follow-up, the patient’s eyes had returned to normal, and his cough was still present but had decreased in severity.

Leopold Simma, M.D. , and Maxine Gesch, M.D.
Published December 11, 2024
N Engl J Med 2024;391: e59
DOI: 10.1056/NEJMicm2409052
VOL. 391 NO. 23

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