Case 146 Medical history An 8 year-old female patient attends to the emergency department due to fever, coughing and dyspnea for the past 7 days. The physical examination showed nail clubbing ,respiratory labor, saturation of 67% in room air, with bilateral and diffuse crackles. Oropharinx culture grew oxacilin sensitive Staphylococcus aureus, Buhloderia cepacea e Stenetrophomonas maltophilia. Image 1: Patient's left hand.Image 2: Chest radiography. Question:Based on the clinical picture, which one is the most likely diagnosis? Primary cilliary dyskinesia Cystic fibrosis with pulmonary exacerbation Acute viral bronchiolitis Bronchiolitis obliterans Time is Up! Time's up