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Vaccine Associated Paralytic Poliomyelitis Unmasking Common Variable Immunodeficiency. BACKGROUND: Oral polio vaccine can rarely lead to Vaccine-associated paralytic poliomyelitis (VAPP). CASE CHARACTERISTICS: A 2-year-old child with asymmetric paralysis of lower limbs following first booster of oral polio vaccine; type 2 Vaccine-derived poliovirus (VDPV) isolated. Subsequently, the child was diagnosed to have common variable immunodeficiency. OUTCOME: Paralysis gradually improved on follow-up; monthly intravenous immunoglobulin therapy started for primary immunodeficiency. MESSAGE: We need to evaluate children with VAPP for underlying immunodeficiency.