Recurrent Aseptic (Mollaret's) Meningitis in a Patient with HIV.

Abstract

INTRODUCTION Pierre Mollaret first described recurrent episodes of aseptic meningitis in 1944.1 Since it was first noted, several etiologies have been suggested, however, with the development of polymerase chain reaction (PCR), it is now known that patients with Mollaret’s meningitis contain Herpes Simplex Virus type 2 (HSV-2) in their cerebrospinal fluid (CSF) and the recurrent symptoms are due to reactivation of the virus.2 The CSF analysis often reveals a polymorphonuclear pleocytosis with large (Mollaret) cells early in the course of illness, followed by a lymphocytic predominance found later.3 Patients commonly present with meningeal symptoms, including fever, headache, and neck stiffness, and signs including positive Kernig and Brudzinski signs.4 They also often present with a recurrence of these symptoms, but the recurrence rate and previous medical history is extremely variable.5,6 In patients with human immunodeficiency virus (HIV), given their immunosuppressive state, meningitis can be caused by various etiologies, including bacterial, fungal, and viral pathogens, including HIV itself. While cryptococcal meningitis is the most common cause of meningitis, opportunistic infections such as cryptococcus primarily infect individuals with a CD4 count less than 350.7 In this case, a patient with HIV and aseptic meningitis is presented.