ABCD1 and X-linked adrenoleukodystrophy: This case underscores the importance of incorporating metabolic leukodystrophies into the evaluation of chronic myelopathies without an evident cause, emphasizing the diagnostic value of peroxisomal biochemical testing and ABCD1 genetic analysis. Non-classical findings, such as chronic alopecia in this patient, are likely incidental, and their clinical significance remains uncertain, warranting no definitive association with X-ALD at present.