Toxocara seropositivity in sensory-predominant cervical myelitis from an endemic region: A six-case series and systematic review.

BACKGROUND

Toxocara species are globally prevalent zoonotic helminths. Spinal neurotoxocariasis is uncommon but clinically relevant because it may mimic inflammatory demyelinating myelitis.

OBJECTIVE

To describe a six-patient institutional series of sensory-predominant cervical myelitis with Toxocara seropositivity from an endemic region and to contextualize these cases within the published literature.

METHODS

We retrospectively reviewed six institutional cases of sensory-predominant non-compressive cervical myelitis associated with positive Toxocara serology and performed a structured literature review of reports published from January 1980 to March 2025. Institutional cases were classified by diagnostic confidence according to microbiologic support and exclusion of alternative diagnoses. No case was labelled definitive without histopathologic proof or paired CSF/serum confirmation; serum Western blot-supported cases were classified as higher-support/probable, whereas serum ELISA-only cases were classified as possible.

RESULTS

Thirty-two published cases met inclusion criteria. Thoracic and cervical lesions predominated, eosinophilia was inconsistent, and most reported patients improved after albendazole-based therapy. Clearly sensory-only myelitis was rarely documented in the published literature; most reports described mixed sensory, motor, and/or autonomic syndromes or lacked sufficient symptom detail for confident classification. In contrast, the institutional series showed a sensory-predominant cervical pattern: five patients had sensory-only myelitis and one had sensory-predominant myelitis with mild urinary urgency and gait imbalance. Two cases had stronger supportive serologic evidence based on serum Western blot positivity, whereas four cases had serum ELISA positivity only and were classified as possible Toxocara-associated myelitis. Clinical improvement was described as an outcome and was not used as diagnostic confirmation because all patients received corticosteroids with albendazole.

CONCLUSION

Toxocara-associated myelitis should be considered in non-compressive cervical or thoracic cord lesions in endemic settings, but diagnostic certainty varies across cases and positive serum ELISA alone should not be interpreted as definitive evidence of CNS infection. The institutional series supports a sensory-predominant cervical pattern while underscoring the need for paired serum/CSF testing, standardized imaging, and follow-up MRI when feasible.