Despite the splenomegaly, autoimmune-mediated cytopenias, and question of an elevated double-negative T cell population (Table 3), the patient screened negative for ALPS on gene sequencing and analysis and otherwise does not fit the full ALPS presentation given the preserved population of memory B cells, the defect in T cell proliferation, and the normal levels of total IgG and IgM in this case [7]. The gene discussed is CD40LG; the disease is autoimmune lymphoproliferative syndrome.