Recurrent Aseptic Meningitis From Herpes Simplex Virus-2: Mollaret's Meningitis in a 30-Year-Old Female

Aseptic meningitis is most commonly caused by herpes simplex virus (HSV), most often viral subtype 2. While typical meningeal symptoms include headache, photophobia/phonophobia, and nuchal rigidity, these are often much less severe than in bacterial meningitis. Rarely, patients may develop recurrent episodes of aseptic meningitis, sometimes with years between each presentation. A minimum of three episodes with at least one documented viral identification is classified as Mollaret meningitis. First described by Mollaret in 1945, the condition is self-limiting and often requires no intervention or suppressive antivirals. In fact, antiviral therapy may increase frequency of presentation. Our patient presented for her third bout of meningitis, with viral polymerase chain reaction positive for HSV-2 on lumbar puncture. The patient was successfully managed with supportive care without further suppressive antiviral therapy. As the disease is self-limiting, clinician education can mediate patient expectations, reduce unnecessary antiviral usage, and decrease superfluous healthcare resource utilization.