SHM Converge Scientific Abstract ePoster Gallery-Mimic Stroke Presentation: A Rare Case of Mollaret's Meningitis

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This case describes a 42-year-old woman who presented to the emergency department with sudden right-sided weakness and numbness, a posterior pressure-like headache, and a painful right buttock lesion. Because of the acute focal neurologic deficits, a stroke code was activated. However, CT and CT angiogram showed no large vessel occlusion or stenosis. Neurologic exam revealed 3/5 weakness in the right upper and lower extremities with brisk reflexes but intact sensation.<br /><br />Further evaluation included MRI, which showed only subtle, nonspecific scattered subcortical white matter changes in the bilateral frontal and parietal lobes. On additional history, clinicians learned the patient had experienced two prior shingles flares involving the right buttock along with intermittent neck stiffness. Infectious Disease was consulted, and due to concern for Mollaret’s meningitis, she was started on high-dose valacyclovir for 10 days. PCR swabs from the lesion were positive for HSV-1 and HSV-2.<br /><br />Mollaret’s meningitis is a rare form of recurrent aseptic lymphocytic meningitis characterized by episodes of headache, neck stiffness, photophobia, nausea, vomiting, myalgias, fever, and sometimes neurologic symptoms such as visual changes, speech impairment, facial weakness, or even coma. Diagnosis is challenging because there is no single confirmatory test; it depends on clinical suspicion, laboratory studies, and imaging to exclude other causes.<br /><br />The patient improved clinically and was discharged on lifelong antiviral prophylaxis and home physical therapy. This case highlights that Mollaret’s meningitis can mimic stroke and underscores the importance of recognizing recurrent meningitis symptoms, rash history, and HSV infection to avoid misdiagnosis.

Asset Subtitle

Hong Yu Wang

Meta Tag

Author List Destiny Nguyen, Erica Grabscheid, Hong Yu Wang, Samuel Tan, Svetlana Chernyavsky, Yuhong Yang

Category Clinical Vignettes

Concept Mollarets Meningitis

Concept Recurrent Meningitis

Concept HSV

Concept HSV Testing

Concept Meningitis Symptoms

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel

Presenting Author Hong Yu Wang

Track Adult

Keywords

Mollaret’s meningitis

HSV-1

HSV-2

stroke mimic

acute right-sided weakness

recurrent aseptic meningitis

shingles flare

posterior headache

valacyclovir

PCR positive

Mollarets Meningitis

Recurrent Meningitis

HSV

HSV Testing

Meningitis Symptoms