Recurrent Aseptic (Mollaret) Meningitis: A Case Report

Mollaret meningitis is a rare form of recurrent, self-resolving, aseptic meningitis with a high rate of return. Although it has been associated with several conditions, herpes simplex virus type 2 (HSV-2) is most common. Diagnosis requires recurrent (>3) episodes of aseptic meningitis as defined by pleocytosis in cerebrospinal fluid (CSF) with negative bacterial cultures. Management is controversial but focuses primarily on supportive care with a potential role for antiviral therapy in both treatment and prevention of recurrence. This case describes a 35-year-old male with fourteen prior episodes of meningitis presenting with a recurrence of symptoms. CSF studies showed an aseptic meningitis due to HSV-2. He was treated with antiviral therapy and ultimately discharged on daily valacyclovir for recurrence prevention. Increased awareness of this condition amongst emergency physicians may help reduce resource utilization and unnecessary antibiotics, while also enhancing appropriate follow-up and prevention of recurrence.