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Program

Internal Medicine

Training Level

Resident PGY 2

Institution

Henry Ford Macomb

Abstract

Mollaret syndrome is a rare form of recurrent lymphocytic meningitis. It is defined as recurrent episodes of acute attacks that last usually few days and separated by symptom free periods that can last months to years. Herpes simplex virus 2 (HSV-2) is responsible for the majority of cases. Diagnosis is usually made by isolating the virus DNA from the CSF. Treatment with antivirals as a herpetic infection has been used and showed some success. Here we present a 66-year old male with past medical history of genital herpes who presented with his third episode of meningitis. Patient presented with low grade fevers, chills, vomiting and occipital headache. He had no active genital lesions. He had similar presentation 15 and 25 years ago. His cerebrospinal fluid analysis (CSF) was consistent with viral meningitis and HSV-2 DNA was detected in the CSF. Antiviral therapy was initiated, and he had significant improvement in his symptoms. Suppressive therapy was not started on that patient due to infrequency of attacks. He remains symptoms free after 16 months follow up.

Mollaret syndrome is a rarely encountered medical condition. Its prevalence is estimated to be 2.2/100,000. It has an unpredictable recurrence rate and the risk of permanent neurologic damage increases with each recurrence. Treatment for acute attacks has been shown to decrease severity and duration of symptoms. One study showed that suppressive therapy with Valacyclovir had no benefits. Whether suppressive therapy would decrease recurrence rate or protect from neurologic damage still needs to be evaluated.

Presentation Date

5-2020

Recurrent benign lymphocytic meningitis in a 66-year-old male diagnosed with Mollaret syndrome. Is suppressive therapy necessary?

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