Department of Internal Medicine, Rochester General Hospital, Rochester, USA.
Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal.
JNMA J Nepal Med Assoc. 2021 Sep 11;59(241):916-918. 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.
莫拉雷氏脑膜炎是一种无菌性复发性良性淋巴细胞性脑膜炎，持续 2-5 天，可在数年内反复发作，每次发作之间症状完全自行缓解。一位 88 岁男性，在最近耳部感染后出现急性头痛、嗜睡和意识改变。他过去有多次类似发作，每次发作前都有耳部或鼻窦感染，脑脊液检查符合无菌性脑膜炎。然而，从未确定过具体的致病原因。他表现为意识混乱、定向障碍和嗜睡，生命体征和全身检查正常。血液检查显示白细胞增多伴中性粒细胞增多。脑脊液分析显示细胞计数增加，以淋巴细胞为主，蛋白升高，聚合酶链反应阴性。脑磁共振成像显示慢性小血管缺血性改变。他符合临床诊断的布鲁因标准。他在住院期间接受了阿昔洛韦经验性治疗，由于脑脊液分析、培养和多重聚合酶链反应均为阴性，未预防性使用抗病毒药物出院。
