Herpes simplex-2 meningitis presenting with headache in pregnancy

Herpes simplex virus (HSV) is a double-stranded DNA virus, whose primary target is epithelial cells. It is disseminated by hematogenous spread. HSV type 2 (HSV-2) usually causes genital infection with mucocutaneous lesions or it may be asymptomatic. HSV-2 is also an important cause of meningitis either during primary infection or by (recurrent) reactivation of dormant virus within the central nervous system. The authors present the case of a nulliparous woman in her mid-20s presenting to the emergency department at 22 weeks' gestation with acute onset of headache. CT of the head and magnetic resonance angiography (MRA) were unremarkable. She received broad-spectrum antimicrobial therapy for suspected meningitis. Her cerebrospinal fluid culture detected HSV-2. She denied a history of oral or genital herpes. She commenced treatment with intravenous acyclovir 10 mg/kg 8 hourly for 7 days. She responded clinically and her headache resolved. There remains a relative dearth of cases of HSV-2 meningitis reported in the literature hence making pregnancy management and delivery planning challenging for obstetricians. This case demonstrates the importance of the multidisciplinary team involvement of genitourinary medicine and sexual health physicians, obstetricians and neonatologists with formal documentation of a birth and postnatal care plan.