SHM Converge Scientific Abstract ePoster Gallery-Balancing the Autoimmune With Immune Activation: Management of Mollaret's Syndrome in a Liver Transplant Recepient

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This poster describes a 39-year-old woman with a history of primary sclerosing cholangitis status post-liver transplant, immunosuppression with cyclosporine, ankylosing spondylitis, MGUS, and migraines who presented with 2 weeks of progressive headache, fever, neck stiffness, photophobia, and meningismus. Initial evaluation showed leukocytosis and clinical concern for meningitis, so she was started on broad-spectrum antibiotics and acyclovir. Lumbar puncture confirmed HSV-2 PCR positivity, and MRI showed leptomeningeal enhancement consistent with aseptic meningitis.<br /><br />She was diagnosed with Mollaret’s meningitis, a rare form of recurrent aseptic meningitis typically associated with herpes simplex virus, based on input from Infectious Disease, Neurology, and Transplant Medicine. Her prior migraine history may have masked earlier episodes. She was treated with IV antivirals for 5 days and then transitioned to lifelong valacyclovir prophylaxis because of her immunosuppressed post-transplant status. She improved and had no further episodes while on prophylaxis.<br /><br />The discussion emphasizes that Mollaret’s meningitis is under-recognized and often presents with recurrent episodes of severe headache, fever, and meningismus that resolve spontaneously. Diagnosis can be difficult and is guided by clinical recurrence and cerebrospinal fluid findings. The authors note that in immunocompetent patients, treatment is often episodic, but in this immunosuppressed liver transplant recipient, continuous prophylaxis was favored.<br /><br />The poster concludes that better recognition of Mollaret’s meningitis may prevent unnecessary antibiotic use, reduce repeated hospitalizations, and improve management in patients with recurrent aseptic meningitis, especially those with altered immune states.

Asset Subtitle

Suma Harsha Kosuru

Meta Tag

Author List Preethash I. Sundar, Sheetal Wadera, Suma Harsha Kosuru

Category Clinical Vignettes

Concept Mollarets Meningitis

Concept Herpes Simplex Virus 2

Concept Cerebrospinal Fluid Polymerase Chain Reaction

Concept Recurrent Meningitis

Concept Aseptic Meningitis

Distinguished Non-Finalist

Presenter Organization Mountain Vista Medical Center

Presenting Author Suma Harsha Kosuru

Track Adult

Keywords

Mollaret’s meningitis

HSV-2

aseptic meningitis

liver transplant

immunosuppression

valacyclovir prophylaxis

cytomegalovirus

leptomeningeal enhancement

lumbar puncture

recurrent headache

Mollarets Meningitis

Herpes Simplex Virus 2

Cerebrospinal Fluid Polymerase Chain Reaction

Recurrent Meningitis

Aseptic Meningitis