Helminth or Host? Rethinking the Etiology of Transverse Myelitis

Abstract

We read with great interest the case report by Murray et al describing transverse myelitis associated with helminthic infection. While intriguing, several aspects of the diagnostic workup and clinical interpretation warrant further clarification. Pain, treatment response, and cerebrospinal fluid (CSF) and radiological follow-up findings suggest that a demyelinating centrale nervous system (CNS) disorder, such as MOG antibody-associated disease, multiple sclerosis, or neuromyelitis optica spectrum disorders (NMOSD), could represent a plausible alternative explanation. Additional investigations, including antibody testing and serial magnetic resonance imaging (MRI), would have strengthened the diagnostic conclusions. We argue that a more comprehensive assessment is essential to avoid premature attribution of the clinical picture solely to helminthic infection.