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.

Based on the clinical picture, which one is the most likely diagnosis?

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