HSV-2 associated meningitis case: a challenging diagnosis in an immunocompetent woman

Herpes simplex virus type-2 (HSV-2) associated aseptic meningitis is rarely seen in healthy individuals. Herein, we report a rare case of meningitis, associated with HSV-2, without the presence of genital lesions. A healthy, 40-year-old female was presented to the emergency service with unremitting headache, vomiting and nausea. Her cerebrospinal fluid (CSF) revealed elevated protein level of 308,2 mg/dL, high leukocyte cell count of 1,118,000 cells/µL with 98% lymphocytes and 2% polymorphonuclear neutrophils (PMNs). The bacterial culture and gram staining of CSF were negative. Real-time quantitative polymerase chain reaction (RT-qPCR) CSF analysis indicated the presence of HSV-2. The cranial MRI revealed meningeal contrast enhancement. The patient was administered acyclovir for 10 days during her hospital stay and she was discharged without any neurological sequela. The patient has a history of herpes infection. This case report shows that HSV-2 meningitis can occur in immunocompetent individuals via re-activation and should always be considered by the clinicians even in the absence of genital lesions.