Vaccine strain varicella-zoster virus–induced central nervous system vasculopathy as the presenting feature of DOCK8 deficiency

Central nervous system (CNS) manifestations have been reported in patients with DOCK8 deficiency, but progressive multifocal leukoencephalopathy caused by the John Cunningham virus has been considered the only known viral etiology to date.1,2 A 6-year-old boy with atopy and recurrent peripheral blood eosinophilia developed acute intermittent vomiting, diarrhea, headache, and dizziness. To determine the VZV genotype, Förster Resonance Energy Transfer PCR was used to identify specific VZV DNA sequence polymorphisms within VZV open reading frames 38, 54, and 62, which distinguishes vaccine VZV from wild-type virus (see Table E1 in this article's Online Repository at www.jacionline.org).3 This confirmed Oka varicella vaccine strain in the CSF.