You have been consulted to a see a patient in the hospital. He is a 5-month-old who presented to the hospitalist service with a 7-day history of cough, rhinorrhea, and bilateral eye discharge. He had been started on Amoxicillin at the start of the symptoms 7 days ago; however, he has not been getting better on the antibiotic therapy. He was noted to have an elevated white blood cell count at the outside facility and was transferred to your facility for further management. Physical exam is positive for bilateral eye drainage and thick rhinorrhea. He has hepatomegaly (tip palpable about 6 cm below the right costal margin) and splenomegaly (tip palpable about 9cm below the left costal margin). The remainder of the physical exam is normal. Labs on admission show WBC 31,400; Hgb 8.5; platelet count 81,000. ANC is 4,400. Marked polychromasia and schistocytes are present. Thirty-three nucleated RBCs per 100 WBCs are present as well. Respiratory viral panel is negative. Complete metabolic panel is within normal limits. The chest X ray shows diffuse increased density of the bones of the axial and visualized appendicular skeleton with areas of periosteal reaction, most pronounced along the proximal humeri bilaterally.