Acute recurrent lymphocytic meningitis in an immunocompetent HIV-positive African woman: Is it a Mollaret’s meningitis or not?

Abstract

We report a case of acute recurrent meningitis in an HIV-positive immunocompetent woman. In this case, a 34-year-old African woman with a known HIV infection presented with symptoms of acute meningitis. She was on combination antiretroviral therapy with abacavir, lamivudine, and nevirapine. Her HIV RNA level was <70 IU/mL, and CD4 counts were 640 cells/mm3. This indicates that she was not immunocompromised. She was febrile on examination, with marked neck stiffness. Her cerebrospinal fluid revealed raised white cell counts with 100% lymphocytes and mildly raised protein. Polymerase chain reaction confirmed herpes simplex type 2 meningitis. She recovered fully with aciclovir 800 mg three times a day. However, she was readmitted with a similar presentation 5 months after the initial admission. Her cerebrospinal fluid confirmed recurrent herpes simplex type 2 meningitis. This case alerts the profession to the possibility of non-opportunistic infections in an immunocompetent HIV-positive patient and of herpes simplex virus type 2 causing recurrent lymphocytic meningitis.

A case report of benign recurrent aseptic meningitis and literature review

“…The cerebrospinal fluid pressure was normal or slightly increased, and the highest report was 370 mmH 2 O at present (Gadhiya & Nookala, 2020). In addition, lymphocytes were dominant, protein was slightly increased, the ratio of glucose to chloride was normal (Yoganathan et al, 2017). Mollaret cells may be found in some patients during the first 24 hours, which are formed when monocytes are invaded by the virus (Rigi et al, 2015).…”