A diagnosis of Hyper-IgM-like CVID was established at age 54, prompted by a history of three pneumonia episodes requiring hospitalization in the preceding year, alongside a complex clinical-immunological-radiological profile marked by fungal susceptibility (manifesting as facial demodicosis), persistent CMV blood viral load <300 DNA copies/ml, and immune dysregulation, including:. Here, CD40LG is linked to pneumonia.