Why the study?
Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines.
Stem cell transplant combined with targeted antiviral and antimycobacterial therapy can successfully treat vaccine-associated paralytic polio and BCG disease in patients with severe combined immunodeficiency.
Supports stem cell transplant plus antivirals for polio-BCG in SCID; hypothesis-generating, needs prospective validation.
Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.
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Ranchod et al. (2024) studied this question.
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