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Background and purposeData on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited.MethodsThis was a nationwide population‐based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV‐2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single‐episode HSV‐2 meningitis were included for comparison.ResultsForty‐seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single‐episode HSV‐2 meningitis were included. The progression risk from HSV‐2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%–30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single‐episode HSV‐2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1–4) were less frequent in BRLM at all post‐discharge follow‐up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%–12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02–15.3) for patients with three or more previous episodes of meningitis.ConclusionsClinical features of BRLM were similar to those of single‐episode HSV‐2 meningitis, whilst post‐discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.
Background and purposeData on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited.MethodsThis was a nationwide population‐based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV‐2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single‐episode HSV‐2 meningitis were included for comparison.ResultsForty‐seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single‐episode HSV‐2 meningitis were included. The progression risk from HSV‐2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%–30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single‐episode HSV‐2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1–4) were less frequent in BRLM at all post‐discharge follow‐up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%–12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02–15.3) for patients with three or more previous episodes of meningitis.ConclusionsClinical features of BRLM were similar to those of single‐episode HSV‐2 meningitis, whilst post‐discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.
Mollaret’s meningitis is a rare neurological disorder characterized by recurrent episodes of aseptic lymphocytic meningitis, often associated with herpes simplex virus 2 (HSV-2) infection. We report the case of a 39 y.o. Italian woman who experienced four episodes of aseptic lymphocytic meningitis between 2004 and 2023, diagnosed as Mollaret’s meningitis. In each episode, the patient presented with fever, severe headache and photophobia. In two episodes cutaneous vesicles in the left gluteal area preceding meningitis symptoms were also reported. A diagnostic evaluation included a physical–chemical analysis and a real-time PCR of the cerebrospinal fluid (CSF). The CSF presented pleocytosis with lymphocytic predominance and a positive HSV-2 load, with a peak of 1234 copies/mL. The patient was treated successfully with acyclovir, and the symptoms resolved without neurological sequelae. This case highlights the importance of comprehensive diagnostic testing and vigilant monitoring to manage Mollaret’s syndrome effectively.
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