Does he have EBV antibodies? I would not be dissuaded from considering XLP especially if he does not have anti-EBV antibodies – only a third of patients with XLP have immunodeficiency as far as I understand. Age is obviously against him, but manifestation of the condition does require exposure to EBV and conceivable (albeit unlikely?) that this had not happened previously…?
Would however be concerned about primary marrow problem with secondary VZV and EBV. Assume rest of haematopoetic cells are normal ? Has he had a bone marrow exam? Etc
SA
Stephen Adelstein
Head, Department of Clinical Immunology | Royal Prince Alfred Hospital
Missenden Road, Camperdown, NSW 2050 Australia
Tel 02 9515 7585 | Fax 02 9515 7762 | stephen.adelstein@sydney.edu.au
