Benign Recurrent Aseptic Meningitis (Mollaret's Meningitis) in an Elderly Male: A Case Report

• Published in: JNMA; journal of the Nepal Medical Association Vol. 59; no. 241; pp. 916 - 918
• Main Authors: Chand, Swati, Thapa, Sangharsha, Gautam, Khusal, Twayana, Anu Radha, R Laguio-Vila, Maryrose, Elsourbagy, Tarek
• Format: Journal Article
• Language: English
• Published: Nepal Journal of the Nepal Medical Association 11-09-2021; Nepal Medical Association
• Subjects: Acyclovir - therapeutic use; Aged; Aged, 80 and over; aseptic meningitis; benign recurrent; Case Report; Herpesvirus 2, Human - genetics; Humans; Male; Meningitis, Aseptic - cerebrospinal fluid; Meningitis, Aseptic - diagnosis; Meningitis, Aseptic - drug therapy; Mollaret's meningitis; Polymerase Chain Reaction; Recurrence; aseptic meningitis; benign recurrent; Mollaret's meningitis
• ISSN: 0028-2715; 1815-672X
• DOI: 10.31729/jnma.6950

Mollaret's meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn's criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.