Mollaret's meningitis and differential diagnosis of recurrent meningitis: Report of case, with review of the literature

Abstract

The clinical features in a patient with recurrent brief episodes of aseptic meningitis are described. They were identical to those in an entity known as Mollaret's meningitis and ours is the first recorded instance of this disease in the United States. Large fragile “endothelial” cells were observed in the cerebrospinal fluid as well as a mild degree of hypoglycorrhachia and a mild increase in gamma globulins. There was a tendency toward leukopenia and mild eosinophilia during the symptom-free intervals. There was also a modest increase in the concentration of immunoglobulin M (IgM) in the serum. The data in nineteen previously recorded cases of Mollaret's meningitis are reviewed, and the occurrence of transient neurologic manifestations in some of them is stressed. These include coma, grand mal seizures, syncope, delirium, hallucinations, anisocoria, absence of abdominal reflexes, visual disturbances, diplopia, speech impairment, disequilibrium, facial paresis and unilateral or bilateral Babinski reflexes. However, in patients with Mollaret's disease most episodes are characterized by a mild meningitis without any associated additional neurologic abnormalities. Conditions which should be considered in differential diagnosis of recurrent meningitis or low grade fluctuating encephalomeningitis or meningitis are discussed. It is our opinion that, although at times there may be difficulties in differentiating it from other conditions, Mollaret's meningitis is a distinct, albeit rare, clinical entity.