Introduction

We read with interest the article by Tuychiboeva et al. about two pediatric patients (Patient-1, 4 years old, boy; Patient-2, 6.5 years old boy) who were both diagnosed with Guillain-Barré syndrome (GBS) of the acute inflammatory demyelinating polyneuropathy (AIPD) subtype, triggered by an adenovirus infection.¹ Patient-1 partially recovered after administration of intravenous immunoglobulins (IVIG), and Patient-2, who also required mechanical ventilation for 7 days, showed improvement after IVIG administration and plasmapheresis.¹ The study is interesting, but a couple of points require discussion.

First, alternative triggers of GBS were not considered and ruled out in the two patients.¹ Since adenoviruses rarely cause GBS² and the patients were recruited during the pandemic, testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) would have been essential. Because SARS-CoV-2 can be associated with superinfections³ and is a common trigger of GBS, it is conceivable that the actual cause of GBS was a SARS-CoV-2 infection rather than the adenovirus infection. Furthermore, since patient-2 also presented with gastrointestinal symptoms, it would have been crucial to rule out a prior infection with Campylobacter jejuni, the most common cause of GBS.⁴ Other rare GBS triggers that should have been excluded include infections with cytomegalovirus, hepatitis B and C viruses, Epstein-Barr virus, varicella zoster virus, Zika virus, dengue, and Mycoplasma pneumoniae. It should also be clarified whether the patient had received any vaccinations before the onset of GBS.

The second point concerns the fact that no contrast-enhanced magnetic resonance imaging of the lumbar spine was performed in Patient-1.¹ To document thickening and contrast enhancement of the lumbar nerve roots, it would have been helpful to confirm GBS imaging-based, as was done in Patient-2.

In conclusion, adenoviruses should not be considered as a cause of GBS as long as all other triggers have been thoroughly ruled out.

Author contribution

The authors confirm contribution to the paper as follows: Study conception and design: JF; data collection: JF; analysis and interpretation of results: JF; draft manuscript preparation: JF. All authors reviewed the results and approved the final version of the manuscript.

Source of funding

The authors declare the study received no funding.

Conflict of interest

The authors declare that there is no conflict of interest.