What’s the Best Treatment for This Infant’s Severe Combined Immunodeficiency?

A father of a 6-month-old male brings him to the urgent care center. The father states that he thinks his child has developed an allergic reaction to the vaccines he received during his last routine wellness visit. 

Upon further assessment, the urgent care provider notes multiple necrotizing papules on his trunk and limbs, which the father confirms have been present for about one week. The infant has no significant medical history, and his vaccinations are up to date including a recent Bacillus Calmette-Guérin (BCG) vaccine. 

The urgent care provider recommends further treatment and management, including skin biopsy of the affected sites, and coordinates transfer of the infant to the local hospital’s pediatric intensive care unit (PICU). 

Serum laboratory results collected in the PICU reveal the infant’s T cell receptor excision circles (TREC) are abnormally low, and after additional assessment, severe combined immunodeficiency (SCID) is diagnosed.