Sehgal Abhinav, Pokhrel Esana, Castro Walter R, Haas Christopher J
Internal Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.
Cureus. 2021 May 26;13(5):e15264. doi: 10.7759/cureus.15264.
We report on a patient with Mollaret's meningitis to highlight the appropriate diagnostic criteria and benign prognosis without empiric antiviral therapy. An 83-year-old man with a history of aseptic meningitis of unknown etiology followed by full recovery presented with a two-day history of fevers, generalized weakness, and neurologic abnormalities. Cerebral spinal fluid (CSF) analysis demonstrated lymphocytic pleocytosis consistent with aseptic meningitis. Given his prior noninfectious aseptic meningitis and symptom-free interval, Mollaret's meningitis was suspected and empiric treatment for herpes simplex viruses (HSV) encephalitis with acyclovir was deferred. All CSF studies, including polymerase chain reactions for HSV-1 and HSV-2, returned negative with clinical improvement by the fourth day of admission. For patients suspected to have Mollaret's meningitis, lumbar puncture should be conducted promptly to facilitate diagnosis. Although several reports describe patients with CSF infection, the diagnosis of Mollaret's meningitis should be reserved for noninfectious cases. In such cases, empiric antiviral therapy for HSV encephalitis may be deferred and complete recovery is expected.
我们报告一例莫拉雷脑膜炎患者，以强调适当的诊断标准及无需经验性抗病毒治疗的良性预后。一名83岁男性，既往有病因不明的无菌性脑膜炎病史，后完全康复，此次出现发热、全身乏力及神经功能异常2天。脑脊液（CSF）分析显示淋巴细胞增多，符合无菌性脑膜炎表现。鉴于其既往非感染性无菌性脑膜炎病史及无症状间隔期，怀疑为莫拉雷脑膜炎，暂未给予阿昔洛韦经验性治疗单纯疱疹病毒（HSV）脑炎。所有脑脊液检查，包括HSV-1和HSV-2的聚合酶链反应，均为阴性，入院第4天临床症状改善。对于疑似莫拉雷脑膜炎的患者，应及时进行腰椎穿刺以助诊断。尽管有几份报告描述了脑脊液感染患者，但莫拉雷脑膜炎的诊断应仅限于非感染性病例。在此类病例中，可暂不给予HSV脑炎的经验性抗病毒治疗，预期可完全康复。
