SHM Converge Scientific Abstract ePoster Gallery-Not This Again...a Case of Mollaret's Meningitis

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This case describes Mollaret’s meningitis (MM), a rare form of recurrent aseptic meningitis marked by episodes of meningismus that resolve completely between attacks. It was first described by Pierre Mollaret in 1944, who noted lymphocytic and mononuclear pleocytosis during acute episodes.<br /><br />A 60-year-old woman with hypertension, hyperlipidemia, migraines, and prior HSV meningitis presented with 3 days of bitemporal headache, neck stiffness, and photophobia after a recent upper respiratory infection. She was afebrile and hemodynamically stable, but had a positive Kernig sign and limited neck range of motion. Imaging, including chest X-ray, CT head/spine, and MRI brain, was unremarkable.<br /><br />Lumbar puncture showed lymphocytic pleocytosis, elevated protein, and normal glucose. CSF testing with the BioFire FilmArray meningitis/encephalitis panel was positive for HSV-2, supporting the diagnosis. Mollaret cells were seen within the first 24 hours in the CSF. She was treated with IV acyclovir and discharged on oral valacyclovir.<br /><br />Diagnosis of MM is based on Bruyn’s criteria: recurrent headaches, meningismus, and fevers; episodes separated by weeks to months; spontaneous symptom resolution; CSF pleocytosis with Mollaret cells; and no alternative cause identified.<br /><br />MM has multiple potential causes, including infectious, malignant, benign tumor, medication-related, and autoimmune etiologies. HSV-2 is the most common infectious cause, though HSV-1, EBV, and certain bacteria have also been reported. Noninfectious causes include leptomeningeal metastases, NSAIDs, SLE, and sarcoidosis. Notably, about half of patients with HSV-2 MM do not report a history of herpetic lesions.<br /><br />There is no clear consensus on treatment, but conservative/supportive care is often sufficient. Prognosis is excellent, and episodes typically resolve without lasting neurologic deficits. MM should be considered in any patient with recurrent lymphocytic meningitis to avoid prolonged hospitalization and unnecessary antimicrobial use.

Asset Subtitle

Yoo Mee Shin

Meta Tag

Author List Aaron S. Gillet, Ronnie A. Festok, Yoo Mee Shin

Category Clinical Vignettes

Concept Mollarets Meningitis

Concept Meningismus

Concept Recurrent Lymphocytic Meningitis

Concept Herpes Simplex Virus 2

Concept Cerebrospinal Fluid

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Yoo Mee Shin

Track Adult

Keywords

Mollaret meningitis

recurrent aseptic meningitis

HSV-2

lymphocytic pleocytosis

Mollaret cells

meningismus

lumbar puncture

acyclovir

valacyclovir

Bruyn criteria

Mollarets Meningitis

Meningismus

Recurrent Lymphocytic Meningitis

Herpes Simplex Virus 2

Cerebrospinal Fluid