Nakamura Yoshitsugu, Nakajima Hideto, Kano Yosuke, Unoda Kiichi, Ishida Shimon, Kimura Fumiharu
Division of Neurology, Department of Internal Medicine I, Osaka Medical College.
Rinsho Shinkeigaku. 2016 Nov 29;56(11):785-787. doi: 10.5692/clinicalneurol.cn-000950. Epub 2016 Oct 21.
A 55-year-old woman was diagnosed with aseptic meningitis at the age of 43 and 44. She developed sudden fever and headache, and she showed nuchal rigidity. Cerebrospinal fluid examination revealed pleocytosis (cell count 208/mm) and was positive for herpes simplex virus type 2 (HSV-2) DNA by PCR. Acyclovir was started on the first day of admission, and she was complete recovery. Preserved cerebrospinal fluid specimen from aseptic meningitis at the age of 44 was also positive for HSV-2 DNA by PCR. She was diagnosed with HSV-2 associated recurrent aseptic meningitis (Mollaret's meningitis) with a recurrence after 11-year interval. She repeatedly relapsed genital herpes after 44 years old and she was treated with valacyclovir whenever genital herpes relapses. But she showed no genital herpes at the onset of meningitis. Because HSV-2 is one of the most significant causes of recurrent meningitis, we would like to stress that HSV-2 infection and antiviral therapy should always be kept in mind for a recurrent meningitis case.
一名55岁女性在43岁和44岁时被诊断为无菌性脑膜炎。她突然出现发热和头痛，并伴有颈项强直。脑脊液检查显示细胞增多（细胞计数208/mm），通过聚合酶链反应（PCR）检测，脑脊液中单纯疱疹病毒2型（HSV-2）DNA呈阳性。入院第一天开始使用阿昔洛韦治疗，她完全康复。44岁时无菌性脑膜炎留存的脑脊液标本通过PCR检测HSV-2 DNA也呈阳性。她被诊断为HSV-2相关复发性无菌性脑膜炎（莫拉雷脑膜炎），间隔11年后复发。44岁后她反复复发生殖器疱疹，每当生殖器疱疹复发时均接受伐昔洛韦治疗。但在脑膜炎发作时未出现生殖器疱疹。由于HSV-2是复发性脑膜炎最重要的病因之一，我们想强调对于复发性脑膜炎病例应始终牢记HSV-2感染及抗病毒治疗。
