Mollaret cells detected in a patient with varicella-zoster virus meningitis

Ohmichi, Takuma; Takezawa, Hidesato; Fujii, Chihiro; Tomii, Yasushi; Yoshida, Tomokatsu; Nakagawa, Masanori

doi:10.1016/j.clineuro.2012.02.015

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…Unfortunately, in our patient, lumbar puncture was performed at least four days after the onset of symptoms on both presentations with resultant CSF analyses demonstrating the presence only of lymphocytes, beyond the temporal window for visualization of Mollaret cells. Similar monocytic cells have also been described in the CSF of other pathologies such as sarcoidosis, Bechet's disease, varicella zoster virus, herpes simplex virus, and West Nile virus, reducing the specificity of these distinctive cells for Mollaret's meningitis [2,3,[7][8][9]. However, the presence of Mollaret cells may still hold value as a sensitive diagnostic marker to support the diagnosis of Mollaret's meningitis, provided the clinical picture is consistent and the distinguishing symptoms, diagnostics, and/or serologies of the aforementioned alternate pathologies are not present.…”

Section: Discussionmentioning

confidence: 72%

Mollaret’s Meningitis: A Rare Entity

Sehgal¹,

Pokhrel²,

Castro³

et al. 2021

Cureus

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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.

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Section: Discussionmentioning

confidence: 72%

Mollaret’s Meningitis: A Rare Entity

Sehgal¹,

Pokhrel²,

Castro³

et al. 2021

Cureus

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“…3 However, there are reports of Mollaret cells in meningitis secondary to other herpesviruses (eg, herpes simplex virus 1 (HSV-1), varicella zoster virus (VZV)) and West Nile Virus. 4 In addition to virologic testing, CSF should be reviewed for Mollaret cells when evaluating a case of recurrent aseptic meningitis.…”

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confidence: 99%

Mollaret Cells in Recurrent Benign Lymphocytic Meningitis

Gluck

Robbins

Galen

2018

The Neurohospitalist

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“…2,6 Samples obtained beyond this initial period tend to show degenerated cells, termed "phantom cells," characterized by a blurry or hazy cytoplasm and faded chromatin. In fact, FCs have been occasionally reported in rare cases of meningitis of different etiologies.…”

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confidence: 99%

“…2 Many cases reported in the literature as MoM correspond to viral meningitis due to varicella zoster virus and herpes simplex virus 1/2, or to chemical meningitis secondary to benign lesions such as epidermoid cysts. [2][3][4][5][6] However, experts recommend that the term MoM should be reserved for truly idiopathic cases, making this entity a diagnosis of exclusion. When this definition is strictly followed, MoM behaves in a benign fashion, with at least one patient showing repeated bouts of meningitis over the course of 60 years without any permanent neurologic deficits.…”

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confidence: 99%

“…Since FCs are very fragile, they are only seldom detected beyond the first 24 hours of initial clinical presentation. 2,6 Samples obtained beyond this initial period tend to show degenerated cells, termed "phantom cells," characterized by a blurry or hazy cytoplasm and faded chromatin. 7 Despite their epithelioid appearance, electron microscopy reveals that FCs have ultrastructural features consistent with monocytes/macrophages.…”

mentioning

confidence: 99%

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