Recurrent Meningitis and Encephalitis Associated with Herpes simplex Type 2: Demonstration by Polymerase Chain Reaction

Pierre Mollaret described his first case of benign recurrent meningitis in 1928. About 50 years later, he wrote that nothing could be added to the original description and that the etiology remained to be discovered [1]. However, thanks to new technologies such as immu-noblotting and polymerase chain reaction (PCR) it is now sometimes possible to demonstrate the infectious origin of such syndromes. We describe a patient who developed seven episodes of meningitis and encephalitis. These episodes were found to be associated with herpes simplex type 2 (HSV 2) infection. The male patient, born in 1924, had a history of recurrent meningitis and meningoencephalitis between 1974 and 1992. In 1974, 1975 and in February 1979, he was admitted to another hospital for episodes of ‘aseptic meningitis’ with rapid recovery. He was first admitted to our center in May 1979 with fever, headache, drowsiness, and a stiff neck. There were no genital vesicles, and no history of genital herpes was reported. CT brain scan revealed only slight diffuse atrophy. Lumbar puncture showed a high protein level and 960 cells/mm with 59% lymphocytes (table 1). He recovered spontaneously and rapidly. In December 1988, he was admitted for a similar episode with the same symptoms in addition to aphasia and agitation. The EEG displayed abundant diffuse slow activity with anterior predominance. He recovered in 2 days, and developed another similar episode in November 1989. In December 1992, he was hospitalized with fever, aggressiveness and disorientation. His language was inadequate and the patient became confused. The EEG was diffusely slow and irregular with discharges of large slow 5and 6-waves. As in previous episodes, he recovered rapidly. The principal results of CSF analysis are summarized in table 1. In all the samples, immunoblotting demonstrated oligoclonal IgG bands with similar patterns for both CSF and sera. Moreover, some additional CSF-restricted IgG bands were detected. An immunoaf-finity-blotting technique revealed a polyclonal pattern of anti-HSV antibodies present in both serum and CSF, also with some additional