BLS I is a rare disorder with an unknown prevalence. About 30 affected individuals have been described in the medical literature. The condition is likely underdiagnosed, because doctors may not investigate the underlying cause of respiratory tract infections.

BLS I is usually caused by mutations in the TAP1 or TAP2 gene. Each of these genes provides instructions for making a protein that plays a role in helping the immune system recognize and fight infections. In particular, the TAP1 and TAP2 proteins aid the function of MHC class I proteins.

The TAP1 and TAP2 proteins attach (bind) together to form a protein complex called transporter associated with antigen processing (TAP) complex. This complex, which is found in the membrane of a cell structure called the endoplasmic reticulum, moves (transports) protein fragments (peptides) from foreign invaders into the endoplasmic reticulum. There, the peptides are attached to MHC class I proteins. The peptide-bound MHC class I proteins are then moved to the surface of the cell so that specialized immune system cells can interact with them. When these immune system cells recognize the peptides as harmful, they launch an immune response to get rid of the foreign invaders.

Mutations in the TAP1 or TAP2 gene prevent formation of the TAP complex, which impairs the transport of peptides into the endoplasmic reticulum. Because there are no peptides for MHC class I proteins to bind, they are broken down, which results in a shortage of MHC class I proteins on the surface of cells. A lack of these proteins impairs the body's immune response to bacteria, leading to recurrent bacterial infections. Researchers are unsure why people with BLS I do not also get viral infections, but they suspect that other immune processes are able to recognize and fight viruses. It is also not clear how TAP1 and TAP2 gene mutations are involved in the development of skin ulcers.

Mutations in another gene involved in the attachment of peptides to MHC class I proteins very rarely cause BLS I.