We read with interest the article titled “Herpetic Geometric Glossitis in an Immunocompetent Patient.”1 In the abovementioned article, the patient, a 30-year-old woman, was described as “immunocompetent.” However, it is important to note that immunocompetency is a subjective term. Human Toll-like receptor 3 (TLR3), although apparently unnecessary for host defense against most microorganisms, has been shown to play an essential role in innate immunity against herpes simplex virus (HSV).2 Therefore, preliminary evaluation of TLR3 function may help identify inborn errors of immunity associated with HSV infection.

Of note, numerous inborn errors of immunity have been discovered through the evaluation of patients presenting with severe human herpesvirus infections despite the absence of overt acquired immunodeficiency.3 Thus, documenting normal immunoglobulin levels and excluding human immunodeficiency virus (HIV) infection do not definitively rule out underlying immunologic abnormalities in these individuals.4

Although many primary immunodeficiency disorders manifest during childhood, a substantial number of affected individuals are diagnosed in adulthood, with symptoms appearing after childhood years.5 Primary immunodeficiency disorders remain underreported and insufficiently recognized.6

For these reasons, the term “immunocompetent” should be used cautiously in patients without evident immunodeficiency, since inborn errors of immunity may become clinically apparent later in life. Such patients may be more appropriately described as “supposedly immunocompetent.”