Although it was initially described the 1940s, the cause of Mollaret's meningitis was revealed later to be an infection due to the reactivation of herpes simplex viruses (HSV-2), much more commonly HSV-2 [1] [2] [3]. Due to still undisclosed reasons, Mollaret's meningitis is more commonly seen in females and predominantly affects adults around 35 years of age, but the infection is described across all age groups [1] [2] [3] [4]. The clinical presentation is distinguished by a recurring and sudden onset of headaches that may be quite severe, fever, photophobia, radiculopathy, paresthesias, arthralgia and in about 50% of cases, neurological symptoms - hallucinations, cranial nerve deficits, diplopia, seizures, or even altered consciousness [1] [2] [3] [4]. Patients report maximal discomfort and pain in the first few hours of symptom appearance, after which a gradual decline in severity is observed [1]. Because of a relatively short duration of symptoms (about 1-7 days in most cases), their recurrence (weeks, months or sometimes even years can pass between attacks), as well as their self-limiting nature that does not pose any harm to the patient, the term benign recurrent lymphocytic meningitis (BRLM) is often used to describe Mollaret's meningitis in the literature [1] [5] [6]. The recurrent appearance of symptoms usually lasts over a period of 3-5 years, followed by a spontaneous resolution in virtually all cases [1] [3] [4].

• Fever

  On admission, the vital signs were stable, there was no fever, and a complete physical examination was normal except for the... [dx.doi.org]

  The fever and symptom gradually improved after admission of indomethacin, and he no longer complained any headache or fever after Day 7 ( Figure 1 ). [omicsonline.org]

  Our patient’s presentation fulfilled each of Bruyns requirements with the exception of recurrent fever criteria. Our patient did not present with a fever, nor did she report having a fever before coming to the hospital. [ojhas.org]

  It is characterized by as few as 3 episodes of fever and meningitis lasting 2–5 days with spontaneous recovery. Patients may complain of headache, fever, photophobia, hallucinations, seizures, or altered mental status, such as in our patient. [shmabstracts.com]

• Pain

  I'm so thankful that now I only have the usual symptoms, like stiff neck, pain at base of skull, head aches and pains, and a few others. I definitely prefer it over the seizures. whew! [honeycomb.click]

  Then in June 2009, I was displaying all of the signs again of viral meningitis (weakness, neck pain/stiffness, couldn’t touch my neck to my chest, body pain everywhere, etc.) and my wife took me to the Emergency Department. [globalgenes.org]

  First, as the patient was under enormous work related stress, second, to support the body’s Qi to move and rid the Toxic Heat and third, as he was in pain from severe headache, severe stiff neck and abdominal pain. [saguaroclinic.com]

  For associated pain, consider using Inflacin. Inflacin is a topical pain relief, anti-inflammatory agent. [lifeextensionvitamins.com]

• Asymptomatic

  Attacks that last several days, may be accompanied by generalized myalgia, and are separated by asymptomatic periods lasting weeks or months; 3. [omicsonline.org]

  It is reasonable to obtain an MRI when patients are asymptomatic to ensure that no other abnormality is present which may be causing a recurrent chemical meningitis (e.g. intracranial epidermoid cyst 4 or neurenteric cyst 5 ) which have been reported [radiopaedia.org]

  Do not kiss or share drinks, eating utensils or chap-stick with individuals who have active cold sores (or with anyone who has not been tested for HSV since it can be asymptomatic). [stdcheck.com]

• Malaise

  Neurology A term of waning popularity for recurring and self-limited episodes of aseptic meningitis; MM is of abrupt onset, associated with fever, and pleocytosis of mononuclear cells Etiology Uncertain; at least some cases are due to HSV Clinical Malaise [medical-dictionary.thefreedictionary.com]

  Symptoms are headache, recurrent hyperthermia, nausea, vomiting, neck rigidity, malaise, myalgia, and positive Kernig and Brudzinski signs. Attacks usually lasts 2-3 days, but the attacks recur at regular intervals of several weeks or months. [whonamedit.com]

  The symptoms of a full-blown viral meningitis attack are: Severe headaches Fever Nausea Vomiting Sensitivity to light and/or sound Malaise Neck rigidity Rarer symptoms are: Tachycardia Double Vision Hallucinations Without proper care, symptoms can escalate [michaelhrehor.com]

  Symptoms of Mollaret’s Meningitis include; severe headaches, fever, nausea, vomiting, sensitivity to light and/or sound, malaise, and neck rigidity. [raredr.com]

• Recurrent Infection

  'To be affected five times is unusual, but some forms of viral meningitis are known to cause recurrent infection, and this can be very difficult to live with for people affected.' [dailymail.co.uk]

  Presence of antibodies of the same type as the HSV isolated from genital swab would confirm recurrent infection. [hopkinsguides.com]

  21 ) 37 Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women: a multicenter, double-blind, placebo-controlled trial. [dx.doi.org]

• Vomiting

  He also described benign, recurrent endothelio-leukocytic meningitis in three patients who had short-lived recurrent attacks of fever, headache and vomiting caused by sterile meningitis, with 'fantomes cellulaires' (cell ghosts) in the cerebrospinal fluid [ncbi.nlm.nih.gov]

  She had near-syncope, vomiting, chills, neck stiffness and dizziness, but denied any fever. The headache was progressive and bi-frontal. [dx.doi.org]

  Symptoms are headache, recurrent hyperthermia, nausea, vomiting, neck rigidity, malaise, myalgia, and positive Kernig and Brudzinski signs. Attacks usually lasts 2-3 days, but the attacks recur at regular intervals of several weeks or months. [whonamedit.com]

  All three patients had short-lived attacks of fever, headache and vomiting, meningeal irritation, and generalized myalgia. [karger.com]

  Presentation is usually with fever, myalgia and arthralgia and signs and symptoms of meningism, including neck-stiffness, nausea and vomiting, photophobia, although these are variable 1,2. Etiology The condition by definition is idiopathic. [radiopaedia.org]

• Nausea

  A 57-year-old woman presented to the emergency department (ED) for headache and nausea lasting 2 weeks. She had near-syncope, vomiting, chills, neck stiffness and dizziness, but denied any fever. The headache was progressive and bi-frontal. [dx.doi.org]

  Symptoms are headache, recurrent hyperthermia, nausea, vomiting, neck rigidity, malaise, myalgia, and positive Kernig and Brudzinski signs. Attacks usually lasts 2-3 days, but the attacks recur at regular intervals of several weeks or months. [whonamedit.com]

  Presentation is usually with fever, myalgia and arthralgia and signs and symptoms of meningism, including neck-stiffness, nausea and vomiting, photophobia, although these are variable 1,2. Etiology The condition by definition is idiopathic. [radiopaedia.org]

• Abdominal Pain

  First, as the patient was under enormous work related stress, second, to support the body’s Qi to move and rid the Toxic Heat and third, as he was in pain from severe headache, severe stiff neck and abdominal pain. [saguaroclinic.com]

• Tachycardia

  Symptoms Symptoms of a full-blown recurrent viral meningitis (Mollaret’s) infection include: severe headaches fever (only seen in about half of cases) nausea vomiting sensitivity to light and/or sound malaise neck rigidity Rarer symptoms include: tachycardia [recurrentmeningitis.org]

  Rarer symptoms include tachycardia, double vision and hallucinations. Because of the similarity in symptoms to benign migraine headache, sufferers of Mollaret’s have often been misdiagnosed by medical personnel. [mollaretsmeningitis.org]

  The symptoms of a full-blown viral meningitis attack are: Severe headaches Fever Nausea Vomiting Sensitivity to light and/or sound Malaise Neck rigidity Rarer symptoms are: Tachycardia Double Vision Hallucinations Without proper care, symptoms can escalate [michaelhrehor.com]

• Myalgia

  […] site is intended for healthcare professionals General Practice Notebook Mollaret in 1944 was the first to describe a meningitic syndrome characterised by recurrent febrile episodes of 2-4 days duration with simultaneous headache, neck stiffness and myalgia [gpnotebook.co.uk]

  Symptoms are headache, recurrent hyperthermia, nausea, vomiting, neck rigidity, malaise, myalgia, and positive Kernig and Brudzinski signs. Attacks usually lasts 2-3 days, but the attacks recur at regular intervals of several weeks or months. [whonamedit.com]

  Presentation is usually with fever, myalgia and arthralgia and signs and symptoms of meningism, including neck-stiffness, nausea and vomiting, photophobia, although these are variable 1,2. Etiology The condition by definition is idiopathic. [radiopaedia.org]

• Photophobia

  There was no photophobia or nuchal rigidity on exam, and full neurological exam was nonfocal. Lumbar puncture revealed normal protein and glucose, 3 nucleated cells, no segmented neutrophils, and 65% monocytes/macrophages. [shmabstracts.com]

  Most common clinical presentation was recurrent episodes of headaches and photophobia followed by a sustained mild fever lasting 5-7 days. The CSF showed markedly increased cellularity with pleocytosis. [ncbi.nlm.nih.gov]

  Presentation is usually with fever, myalgia and arthralgia and signs and symptoms of meningism, including neck-stiffness, nausea and vomiting, photophobia, although these are variable 1,2. Etiology The condition by definition is idiopathic. [radiopaedia.org]

• Diplopia

  […] presentation is distinguished by a recurring and sudden onset of headaches that may be quite severe, fever, photophobia, radiculopathy, paresthesias, arthralgia and in about 50% of cases, neurological symptoms - hallucinations, cranial nerve deficits, diplopia [symptoma.com]

  More severe cases can occur with neurological abnormalities, including seizures, diplopia, abnormal reflexes, cranial nerve palsy, hallucinations and coma. [patient.info]

  CASE REPORT A 35-year-old Caucasian woman developed acute intractable headache, fever, neck pain, photophobia, and binocular horizontal diplopia. She had morbid obesity (body mass index of 47.5 kg/m2). [journals.lww.com]

  However, transient neurologic abnormalities (seizures, diplopia, pathologic reflexes, cranial nerve paresis, hallucinations, and coma) occur in as many as 50% of cases. [lifeextensionvitamins.com]

• Suggestibility

  They suggest that cholesterin containing debris entering the subarachnoid space from the tumour cysts provoke an aseptic "chemical" meningitis of short course. [ncbi.nlm.nih.gov]

• Visual Hallucination

  Two patients (age, >70 years) with VZV infection had symptoms at hospital admission, including confusion, memory impairment, and visual hallucinations, which may be suggestive of meningoencephalitis. [doi.org]

• Meningism

  Keywords Meningitis Cerebral Spinal Fluid Aseptic Meningitis Lymphocytic Pleocytosis Recurrent Meningitis These keywords were added by machine and not by the authors. [dx.doi.org]

  It is well known that herpes simplex virus (HSV) type 2 produces acute meningitis, while HSV type 2 rarely causes recurrent meningitis (Mollaret's meningitis). [ncbi.nlm.nih.gov]

• Headache

  A 57-year-old woman presented to the emergency department (ED) for headache and nausea lasting 2 weeks. She had near-syncope, vomiting, chills, neck stiffness and dizziness, but denied any fever. The headache was progressive and bi-frontal. [dx.doi.org]

  One year after the first infection, he developed severe recurrent attacks of headache associated with meningitis symptoms. [ncbi.nlm.nih.gov]

  There is no specific treatment, so management involves supportive measures such as rest, fluids, and medicine to relieve the fever or headache.” [recurrentmeningitis.org]

  Slide of a sample of cerebrospinal fluid (CSF) from a 41-year-old woman with headache, fever and nuchal rigidity. [cmaj.ca]

• Seizure

  Many people have Auras before seizures, which is like warning signs that a seizure is most likely coming on. [honeycomb.click]

  Without proper care, symptoms can escalate to seizures and even coma. Thus, a greater understanding and knowledge of this disease will facilitate better patient care in emergency situations. [recurrentmeningitis.org]

  Anti-seizure medications such as Gabapentin (Neurontin), Pregabalin (Lyrica), Lamotrigine (Lamictal) have also been used. [mollaretsmeningitis.org]

  […] is distinguished by a recurring and sudden onset of headaches that may be quite severe, fever, photophobia, radiculopathy, paresthesias, arthralgia and in about 50% of cases, neurological symptoms - hallucinations, cranial nerve deficits, diplopia, seizures [symptoma.com]

• Neck Stiffness

  A physical examination that will include a comprehensive neurological examination may show a fever and neck stiffness. Sometimes neck stiffness can be more severe when you flex your neck or your legs. [verywellhealth.com]

  She had near-syncope, vomiting, chills, neck stiffness and dizziness, but denied any fever. The headache was progressive and bi-frontal. [dx.doi.org]

  Symptoms of Mollaret meningitis, which last from 1 to 7 days, include headache, neck ache, fever, and neck stiffness. [medicinenet.com]

  This site is intended for healthcare professionals General Practice Notebook Mollaret in 1944 was the first to describe a meningitic syndrome characterised by recurrent febrile episodes of 2-4 days duration with simultaneous headache, neck stiffness and [gpnotebook.co.uk]

  Physical examination was remarkable for neck stiffness but no focal neurologic deficits. CT head was unremarkable. [ojhas.org]

• Irritability

  Mollaret's meningitis is a rare clinical entity consisting of recurrent attacks of meningeal irritation, which, after a sudden onset, last for a few days. The prognosis appears to be excellent, although the aetiology has not been established. [ncbi.nlm.nih.gov]

  A complete physical examination may confirm signs and symptoms suggestive of a meningeal irritation. In that case, appropriate laboratory tests should be obtained. [symptoma.com]

  The Handbook of Clinical Neurology, states: “The syndrome is characterized by attacks of fever associated with signs of meningeal irritation, increased cell count in CSF [cerebral spinal fluid]….and of a self-limited course.” [saguaroclinic.com]

  Recurrent attacks of fever associated with symptoms and signs of meningeal irritation; 2. Attacks that last several days, may be accompanied by generalized myalgia, and are separated by asymptomatic periods lasting weeks or months; 3. [omicsonline.org]

The diagnosis of Mollaret's meningitis may be difficult to make without adequate clinical suspicion, which can only be raised if a complete patient history is obtained. The duration of symptoms, their pattern, as well as recurrence and remission, are highly specific signs of Mollaret's meningitis. In fact, certain reports have emphasized that at least three episodes are necessary in order to consider Mollaret's meningitis in the differential diagnosis [1]. A complete physical examination may confirm signs and symptoms suggestive of a meningeal irritation. In that case, appropriate laboratory tests should be obtained. Cerebrospinal fluid (CSF) examination is recommended in all patients who exhibit signs of a central nervous system (CNS) infection, and a lumbar puncture is necessary to evaluate the CSF contents, but only after an imaging study of the endocranium (computed tomography) is performed. Lymphocytic pleocytosis (an increased number of lymphocytes in the CSF) is one of the most important signs of viral meningitis, while the presence of large granular plasma cells is a distinguishing feature of Mollaret's meningitis [1]. However, they can be detected only in the first 24 hours after symptom onset, and their monocytic-macrophage origin suggests that neutrophilic pleocytosis is also a possible finding, a rare feature seen in West Nile encephalitis as well [1] [6]. Protein levels might be elevated, whereas glucose levels are normal [1]. In addition to clinical and CSF criteria, detection of HSV (either HSV-1 or HSV-2) genetic material (DNA) in CSF by PCR methods is the gold standard for confirming the diagnosis [1] [4] [5] [6]. Because HSV is a rather common cause of viral meningitis, PCR testing should be done whenever CSF shows lymphocytic predominance [6].

• Cerebrospinal Fluid Abnormality

  fluid", [2] cerebrospinal fluid abnormalities may not be detectable for the entire time. [6] Diagnosis can be elusive, as Helbok et al. note: "in reality, many more weeks, even months pass by until the diagnosis is established. [forums.phoenixrising.me]

  fluid",[2] cerebrospinal fluid abnormalities may not be detectable for the entire time.[6] Diagnosis can be elusive, as Helbok et al. note: "in reality, many more weeks, even months pass by until the diagnosis is established. [en.wikipedia.org]

• Herpes Simplex Virus Type 2

  Herpes Simplex Virus type 2 has been the most commonly identified causative agent of Mollaret's meningitis. [ncbi.nlm.nih.gov]

  Herpes simplex virus type 2 (Mollaret's) meningitis: a case report. Int J Infect Dis 2009; 13: e476–9 Google Scholar | Crossref | Medline | ISI [journals.sagepub.com]

  It is a rare type of chronic recurrent, lymphocytic meningitis often caused with the Herpes Simplex virus type 2. [meningitis.com.au]

In our patient, a treatment with indomethacin during the last attack resulted in a clear and rapid improvement of symptoms. Since this episode only mild relapses have occurred, all of which responded well to the same treatment. [ncbi.nlm.nih.gov]

While acute episodes may cause significant symptoms, the long-term prognosis is excellent. [ncbi.nlm.nih.gov]

Treatment and prognosis Although each attack is self limited, given the strong association with HSV-2 therapy and prophylaxis with acyclovir or valacyclovir has been proposed 2. [radiopaedia.org]

No causative etiology was identified although a series of investigations were performed, including studies of the blood and CSF, roentgenogram and nuclear scintinographs. To date, there has been no standard therapeutic modality for this disease. [ncbi.nlm.nih.gov]

Etiology The condition by definition is idiopathic. See the discussion on terminology above. [radiopaedia.org]

In summary, it is well recognized that meningitis is more commonly associated with a viral etiology than a bacterial etiology. [doi.org]

A positive epidemiological history was recorded for 5 patients. [doi.org]

Epidemiology It is very rare and the literature is very limited. Presentation There is a rapid onset of symptoms that are typical of meningitis - eg, fever, headache and neck stiffness. The symptoms last between one and seven days. [patient.info]

The epidemiologic setting (e.g., time of year, geographic locale, exposure to insects, diseases prevalent in the local community) and accompanying systemic manifestations may be helpful in making a presumptive diagnosis. [emedicine.com]

Epidemiology. Ann Neurol 1984 ; 16 : 283 –94. ↵ Tyler K, Adler D. Twenty-eight years of benign recurring Mollaret meningitis. Arch Neurol 1983 ; 40 : 42 –3. ↵ Stoppe G, Stark E, Patzold U. Mollaret’s meningitis: CSF-immunocytological examinations. [jabfm.org]

The possible pathophysiology of this case is discussed. [ncbi.nlm.nih.gov]

Provides in-depth coverage of CSF examination and analysis, CSF physiology and pathophysiology, approach to diagnosis, and future directions in CSF analysis. [books.google.de]

The pathophysiology of Mollaret meningitis remains an enigma, and the therapy consists of supportive care. ( JAMA 236:1967-1969, 1976) Full Text Download PDF Full Text Cite This Citation Haynes BF, Wright R, McCracken JP. [jamanetwork.com]

Pathophysiology Meningitis is inflammation of the meninges. The meninges are three layers of connective tissue that surround and protect the brain and spinal cord. [verywellhealth.com]

Treatment with acyclovir may be beneficial in decreasing the severity and duration of attacks and in preventing further episodes. [Au?1]. [ncbi.nlm.nih.gov]

Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎ [books.google.es]

Preventing HSV infections include: Abstinence or only having sex with one partner who has been tested and does not have the virus. Using condoms, which can help reduce risk –but not necessarily prevent–herpes infection. [stdcheck.com]

1. Shalabi M, Whitley RJ. Recurrent benign lymphocytic meningitis. Clin Infect Dis. 2006;43(9):1194-1197.
2. Kallio-Laine K, Seppänen M, Kautiainen H, et al. Recurrent Lymphocytic Meningitis Positive for Herpes Simplex Virus Type 2. Emerg Infect Dis. 2009;15(7):1119-1122.
3. Poulikakos PJ, Sergi EE, Margaritis AS, et al. A case of recurrent benign lymphocytic (Mollaret's) meningitis and review of the literature. J Infect Public Health. 2010;3(4):192-195.
4. Mirakhur B, McKenna M. Recurrent herpes simplex type 2 virus (Mollaret) meningitis. J Am Board Fam Pract. 2004;17(4):303-305.
5. Abou-Foul AK, Buhary TM, Gayed SL. Herpes simplex virus type 2-associated recurrent aseptic (Mollaret’s) meningitis in genitourinary medicine clinic: a case report. Int Med Case Rep J. 2014;7:31-33.
6. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.