Recurrent aseptic mollaret’s meningitis

Context: Mollaret’s meningitis is a rare disease, where there are recurrent episodes of aseptic meningitis, characterized by fever, headache, meningitis, and cerebrospinal fluid pleocytosis with Mollaret cells, and without neurological sequelae. It is characterized by episodes of illness and episodes of remission, with no detectable etiologic agent. Case report: 38-year-old man, previously healthy, with repeated cases of severe holocranial headache, associated with nausea and vomiting, without fever and with neck pain and stiff neck. The condition was repeated 9 times during the period of 1 and a half years. In the neurological examination (during the symptoms), he presented normal fundus examination, neck stiffness present, without other meningeal signs and focal motor deficits or associated cranial nerves. Extensive serum investigation (including serology, autoimmune markers, and sputum BK test) was performed, all negative. Skull CT and MRI of the skull and cervical spine with contrast during events without abnormalities. Lumbar punctures performed during this period did not show an increase in intracranial pressure on spinal manometry; CSF analyzes showed a clear and colorless appearance, pleocytosis (higher cell count 255 cells), lymphomononuclear predominance, hyperproteinorrhachia(higher value of 100 mg/dl), with normal glucose and lactate. In the CSF samples, extensive etiological investigation (broad viral panel, general bacteria search, syphilis and Mycobacterium tuberculosis, fungi and neoplastic cells) was carried out, all negative. Cisternoscintigraphy performed excluding cerebrospinal fluid fistulas. The patient evolved without neurological sequelae. Conclusions: Mollaret’s recurrent aseptic meningitis is associated with social impairment and functional limitations. Thus, further discussions on conduct and prognosis are needed.