Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 06 16 1 7 Mahsa Rekabi Pediatric Respiratory Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Vahab Rekabi Avesta Pathology and Genetic Lab, Tehran, Iran Esmail Mortaz Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shima Seif Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Sepideh Darougar Department of Pediatrics, Faculty of Medicine, TeMS.C., Islamic Azad University, Tehran, Iran 2025 01 14 2025 11 09 Chronic granulomatous disease (CGD) is the most common inherited phagocytic disorder with an increased susceptibility to recurrent infections and inflammatory manifestations due to a defect in any of the 5 NADPH oxidase subunits. Although CGD may manifest at different ages based on the defects of NADPH oxidase proteins, it is usually diagnosed in childhood with an overall median age of 2.7 to 3 years at the onset. Infections and inflammatory manifestations are known to be two major clinical presentations of CGD, with the infections occurring much earlier in life than the inflammatory manifestations. Despite the patients’ clinical history and their noticeable manifestations, sometimes the diagnosis is delayed until adulthood, which could be attributed to physicians’ low awareness of the disease. Another reason for such delayed diagnosis could be the fact that some CGD mutations may remain asymptomatic up to a certain age. The current study is a report of a healthy woman without any history of recurrent infections or inflammation until she was forty. In her early forties, she contracted a mycobacterial infection that was unresponsive to treatment, and was then diagnosed with abnormal reactive oxygen species released by neutrophils, suggesting a case of CGD. This suggests that primary immunodeficiencies are not solely childhood disorders and should be considered in all refractory or therapy resistant conditions, even in adults. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4308 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4308/2356