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      Herpes simplex virus type 2-associated recurrent aseptic (Mollaret’s) meningitis in genitourinary medicine clinic: a case report

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          Abstract

          Introduction

          Cases of idiopathic recurrent benign aseptic meningitis were first described by Mollaret. Today, herpes simplex virus (HSV) is considered the cause of most cases of Mollaret’s meningitis.

          Case report

          A 40-year-old male was referred to our genitourinary medicine clinic with recurrent genital herpetic lesions. He had HSV-2-positive genital ulcers 8 years earlier. One year after the first infection, he developed severe recurrent attacks of headache associated with meningitis symptoms. The results of all radiological and biochemical tests were normal, but the patient reported a correlation between his attacks and genital herpes flare-ups. We diagnosed the patient with Mollaret’s meningitis and started him on continuous suppressive acyclovir therapy, which resulted in marked clinical improvement.

          Discussion

          Mollaret’s meningitis is a rare form of idiopathic recurrent aseptic meningitis that has a sudden onset, short duration, and spontaneous remission with unpredictable recurrence. We believe that the presence of concurrent or recurrent mucocutaneous herpetic lesions can aid its diagnosis, prior to which, affected patients usually have many unnecessary investigations and treatments. Therefore, detailed sexual history should be sought in all patients with aseptic meningitis, and clinicians should also ask about history of recurrent headaches in all patients with recurrent herpetic anogenital lesions. Continuous suppressive acyclovir therapy may reduce the frequency and severity of attacks and can dramatically improve lifestyle.

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          Most cited references 13

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          Mollaret's meningitis and herpes simplex virus type 2 infections.

          Benign recurrent aseptic meningitis is a rare disorder described by Mollaret in 1944. When initially described, this form of aseptic meningitis had no identifiable infecting agent. New sophisticated diagnostic tools have now identified herpes simplex type 2 virus as the most commonly isolated agent. Antiviral treatment has been used successfully for prophylaxis and treatment.
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            Recurrent Lymphocytic Meningitis Positive for Herpes Simplex Virus Type 2

            We found the prevalence of recurrent lymphocytic meningitis associated with herpes simplex virus type 2 (HSV-2) was 2.2/100,000 population in Finland during 1996–2006, higher than previous estimates. PCR was most sensitive in detecting HSV-2 DNA from cerebrospinal fluid if the sample was taken 2–5 days after symptom onset.
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              Isolation of herpes simplex virus type 1 in recurrent (Mollaret) meningitis

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                Author and article information

                Journal
                Int Med Case Rep J
                Int Med Case Rep J
                International Medical Case Reports Journal
                International Medical Case Reports Journal
                Dove Medical Press
                1179-142X
                2014
                03 March 2014
                : 7
                : 31-33
                Affiliations
                Department of Genitourinary Medicine, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
                Author notes
                Correspondence: Sedki L Gayed, Department of Genitourinary Medicine, East Lancashire Hospitals NHS Trust, St Peter’s Health Centre, Church Street, Burnley, Lancashire, UK, BB11 2DL, Tel +44 12 8264 4301, Email sedki.gayed@ 123456elht.nhs.uk
                Article
                imcrj-7-031
                10.2147/IMCRJ.S58377
                3949723
                24623993
                © 2014 Abou-Foul et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Case Report

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