Q: What is Mollaret's meningitis?
Answer: Mollaret's meningitis is a form of recurrent benign lymphocytic meningitis (RBLM). It is defined as greater than three episodes of fever and meningismus lasting two to five days, followed by spontaneous resolution. It may cause transient seizures, hallucinations, diplopia, cranial nerve palsies, or change in mental illness. The most common cause is HSV-2 virus and may present without any genital lesions at the time of presentation. The diagnosis is made by PCR testing for virus in the CSF. Treatment is valacyclovir, 500 mg twice daily for 12 months. Other causes besides HSV-2 have also been described for Mollaret's meningitis.
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References:
1. Shalabi M, Whitley RJ. Recurrent benign lymphocytic meningitis. Clin Infect Dis 2006; 43:1194.
2. Schlesinger Y, Tebas P, Gaudreault-Keener M, et al. Herpes simplex virus type 2 meningitis in the absence of genital lesions: improved recognition with use of the polymerase chain reaction. Clin Infect Dis 1995; 20:842.
3. Aurelius E, Franzen-Röhl E, Glimåker M, et al. Long-term valacyclovir suppressive treatment after herpes simplex virus type 2 meningitis: a double-blind, randomized controlled trial. Clin Infect Dis 2012; 54:1304.
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