We read with interest the comments made by Al-Mendalawi on our publication,[1] and we thank him for his useful comments and suggestions.This case was initially referred to us from a private hospital for second opinion, and we assumed that the patient was not thoroughly investigated for immune deficiencies as he presented as an acute surgical emergency.[2] Despite this, and to the best of our knowledge, this patient was not HIV positive. HIV infection is, however, very rare in this population while other congenital immune deficiencies are more prevalent.[3,4]We will, however, certainly alert the treating physicians to perform further investigations, if they are not already done on this patient, and will consider this test in any similar cases in the future.