Thus the clinical features of ICOS deficiency parallel those of another T-B cell costimulatory defect, CD40 ligand deficiency, in which patients not only show hypogammaglobulinemia but also evidence of an accompanying T-cell immunodeficiency, commonly in the form of Pneumocystis or Cryptosporidium infections [18]. This evidence concerns the gene CD40LG and hyperinsulinemic hypoglycemia, familial, 4.