Mollaret’s meningitis: An atypical presentation

Introduction: Mollaret’s Meningitis, also known as Recurrent Benign Endothelial-Leukocyte (RBLM) aseptic meningitis, is a rare phenomenon that occurs in a small number of patients who experience meningitis. By definition, Mollaret’s diagnosis requires at least three different acute meningeal attacks. Often, there is no evident trigger for the attacks, however, the association of HSV-2 (Herpes Simplex Virus type 2) with Mollaret’s has been examined in the literature, with most of the case reports involving middle aged females. Case Description: The patient is a 27-year-old male with a past medical history of HIV and Latent Syphilis, presenting with his third episode in the past four years of severe headache, fever, photophobia, and chills. After workup including imaging and PCR, the diagnosis of meningitis due to HSV-2 was made. With consideration of the patient’s history of at least two prior meningitis attacks requiring hospitalization, the diagnosis was further classified to Mollaret’s Meningitis secondary to HSV-2. The patient was discharged after three days of supportive inpatient treatment with a prescription of oral valacyclovir and a referral to neurology. Discussion: This case of Mollaret’s, an already rare disease, presented in a patient that did not fit the typical middle-aged female presentation. It is important to not only be aware of the possibility of Mollaret’s in meningeal patients, but also that it may occur in an even more rare presentation than expected. Making the diagnosis of Mollaret’s in a timely manner is important as it can help decrease morbidity and mortality in the small patient population.