Mollaret's meningitis associated with herpes simplex type 2 infection

Abstract

We describe three patients with benign recurrent aseptic meningitis (Mollaret's meningitis). For one of these cases, the episodes of meningitis were associated with herpetic outbreaks. Mollaret cells, which are a hallmark of Mollaret's meningitis, were present in the CSF from two of the three patients. In all cases, herpes simplex virus type 2 DNA was present in the CSF during the acute illness as detected by polymerase chain reaction amplification, although viral cultures from CSF were all negative. Herpesviruses, notorious for frequent and sporadic recurrence, are ideal candidates for the cause of Mollaret's meningitis.

Recurrent Herpes Simplex Type 2 Virus (Mollaret) Meningitis

“…2,7,8 After the primary infection, Herpes simplex type 2 virus becomes dormant, most commonly within the sensory neurons of the sacral dorsal root ganglia. It is believed that the retrograde seeding of the CSF by the Herpes simplex type 2 virus results in meningitis.…”

HLA-DRB1*01 allele and low plasma immunoglobulin G1 concentration may predispose to herpes-associated recurrent lymphocytic meningitis

“…The causative agent in up to 90% of cases is herpes simplex virus (HSV) 2. In rare cases, RLM is associated with autoimmune diseases or medication [1,2].…”

Herpes simplex virus type 2 recurrent meningitis (Mollaret's meningitis): a consideration for the recurrent pathogenesis

“…Related to the former, Venot et al 5 demonstrated that the identical HSV type 2 strain caused both meningitis and recurrent genital herpes by using PCR study with a restriction enzyme technique. In terms of the latter pathogenesis, a few of the reported cases probably showed a weak antibody response; for example, Picard et al 6 have described one case that was merely positive for both HSV type 1 and type 2, and Cohen et al 7 have described a case that was seronegitive. In our previous case of HSV type 2 recurrent meningitis, serum HSV antibody titers by conventional CF, CF, NT, or EIA were clearly at a low level.…”

“…[1][2][3] To date, approximately 50 cases of herpes simplex virus (HSV) type 2 recurrent meningitis have been reported. [4][5][6][7][8][9][10][11] Polymerase chain reaction (PCR) from cerebrospinal fluid (CSF) can confirm the diagnosis in most patients, aiding further management of the patients, whereas the antibody analysis is not always useful. The pathogenesis of recurrence has Journal of Infection (2005) not yet been clarified; frequently recurring meningitis with or without genital herpes is probably due to particular features of HSV type 2, or low host defence including immune evasion.…”