Approach to primary immunodeficiencies Quiz: Ace Your Exams
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A 3-month-old infant is brought to the emergency department with a 2-day history of cough, decreased oral intake, and high fever (up to 40°C) unresponsive to antipyretics. There is no history of vomiting, seizures, or rhinorrhea. The infant has a history of recurrent ear infections and persistent diarrhea for one month. Birth and family histories are noncontributory. Temperature is 38.4°C (101.1°F), pulse is 198/min, respirations are 54/min, blood pressure is 75/40 mmHg, and oxygen saturation is 99% on room air. Physical examination reveals a white film over the tongue and buccal mucosa, as well as a flaky, dandruff-like rash over the scalp and face. Capillary refill is 2 seconds, and mucous membranes are moist. Cardiopulmonary exam shows tachycardia and tachypnea. Abdominal and neurologic exams are normal. Laboratory findings include a decreased lymphocyte count. A chest radiograph reveals an absent thymic shadow. Which of the following is the best next step in management?
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