a 9-month - old female patient was brought to a health institute with complaints of coughing persisting for 2 weeks .
her hematologic tests revealed the presence of hyperleucocytosis ( 107.000/mm ) , and consequently she was referred to us with the initial diagnosis of leukemia .
her history revealed the presence of vomiting , and diarrhea in addition to her complaints of coughing within the first week . she had nt been vaccinated .
her oropharynx was hyperemic , and crepitant rales were heard bilaterally over basal lobes of her lungs .
some of her laboratory values were as follows : hemoglobin : 10.6 gr / dl , wbc : 102.900/mm , platelets : 797.000/mm , normal hepatic , and renal function test results ; uric acid : 2.5 mg / dl , and ldh : 386 u / l .
results of peripheral smear analysis were as follows : neutrophils : 26% , lymphocyte : 72% , monocyte : 2% , absence of atypical cells , and blast cells .
dimensions of mediastinum were within normal limits , and infiltration in the right paracardiac region was seen .
polymerase chain reaction ( pcr ) performed with throat swab , and respiratory tract panel realized for adenovirus infection yielded positive results .
pcr test could not detect any evidence of pertussis infection . respiratory tract infection caused by an adenovirus , and hyperleucocytosis
day of her hospitalization wbc was 66.680/mm . during follow - up of the patient , her respiratory symptoms , and complaints of coughing regressed at the end of the first week of her hospitalization . on 7 .
whole blood cell counts , and results of her peripheral smear are shown in table 1 .
complaints of the patient regressed , and her clinical problems resolved during her follow - up , and consequently she was discharged with prescription of a vacination plan .
whole blood cell count , and peripheral smear results of the patient x wbc : whole blood cell .
classical whooping cough infection courses with paroxysmal fits of coughing , vomiting after coughing , deep inspirium , and intermittent symptoms of coughing lasting longer than 28 days up to 3 months .
adenovirus infections most frequently present with manifestations of respiratory tract infections , and gastroenteritis . in our patient coughing episodes lasted for 3 weeks , and in the first week diarrhea , and vomiting accompanied complaints of coughing . in the pediatric age group
acute leukemias are the most frequent causes of hyperleukocytosis . apart from leukemias , infections , drugs , bleeding , hypersensitivity reactions , splenectomy , and solid tumors induce leukemoid reaction leading to development of hyperleukocytosis .
however hyperleukocytosis secondary to absolute lymphocytosis is seen in pertussis , tuberculosis , and viral infections . among viral infections ,
whole blood cell count of our patient demonstrated hyperleukocytos , anemia , and reactive thrombocytosis .
apart from bordetella pertussis infection the manifestations of pertussis - like coughing can be encountered during the course of infections caused by chlamydophila pneumoniae , chlamydiae trochomatis , mycoplasma pneumoniae , adenoviruses , and bordetella bronchiseptica . in a study on 149 patients who presented with clinical manifestations of pertussis ,
the most frequently detected infectious agents , apart from bordetella pertussis were adenoviruses , parainfluenza , mycoplasma pneumoniae , and rsv . in this study ,
adenoviruses , and mycoplasma pneumoniae were detected in 3 , and 1.3% of the cases , respectively . in patients presenting with clinical manifestations of pertussis where bordetella pertussis can not be isolated or can not be confirmed serologically , investigation for infectious agents as mycoplasmae , chlamydiae , and adenoviruses has been recommended .
gold standard for the diagnosis of pertussis is detection of bacterial growth on culture which has a 100% specificity .
its sensitivity changes depending on many factors as stage of the disease , initiation of antimicrobial treatment , sampling method , quality of the material used for sampling , conditions of delivery of the sample to the laboratory , and experience of the laboratory , and ranges between 12 , and 60 percent .
the world health organization recommends combined use of antibiograms , and pcr technique for the diagnosis of pertussis .
sensitivity , and specificity of pcr method have been indicated as 7099% , and 86100% , respectively . in our patient bacterial growth
pcr respiratory tract panel revealed presence of adenovirus , and absence of mycoplasma pneumoniae , and rsv .
although the patient presented to our clinic with pertussis - like coughing , complaints of vomiting , and diarrhea at the beginning of the disease , shorter duration of the coughing when compared with whoopig cough , and in consideration of laboratory test results , presumptive diagnosis of pertussis - like syndrome secondary to adenovirus infection , and hyperleucocytosis were made .
since all her necessary vaccinations were not performed , and diagnostic laboratory methods were not 100% sensitive , bordatella infection could not be ruled out conclusively . in conclusion , in patients presenting with clinical manifestations of pertussis , and hyperleucocytosis , if especially etiologic agent can not be cultivated , then adenovirus infections should be considered in the differential diagnosis , and relevant investigations should be carried out .
 adenovirus is an infectious viral agent that causes variety of clinical presentations such as respiratory disease , conjunctivitis , and gastroenteritis . 
 hepatitis , pancreatitis , myocarditis , encephalitis , and disseminated infection are primarily seen in immunocompromised patients . 
 rarely , adenovirus infection can present with pertussis - like syndrome . 
 described here is case of pertussis - like syndrome associated with adenovirus presenting with hyperleukocytosis . 