MIRAGE syndrome arising from SAMD9 mutations can have a spectrum of clinical severity [2, 5]; however, given the early identification of the SAMD9 mutation in this patient, we suspect that the absence of myelodysplasia and the absence of immune deficiency may represent low‐grade disease owing to homeostatic SAMD9 expression prior to IFN‐induced expression of SAMD9 following accumulation of challenges like infection over the course of early life. This evidence concerns the gene IFNA1 and infection.