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Benign Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderly Male: A Case Report

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Abstract: Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

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i Chand Department of Internal Medicine, Rochester General Hospital, Rochester, USA Sangharsha Thapa Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal Khusal Gautam Department of Pediatric Research, Patan Academy of Health Sciences, Lalitpur, Nepal Anu Radha Twayana Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal https://orcid.org/0000-0001-7399-5043 Maryrose R.Laguio-Vila Department of Internal Medicine, Rochester General Hospital, Rochester, USA Tarek Elshourbagy Faculty of Medicine, Cairo University, Egypt

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aseptic meningitis, benign recurrent, Mollaret's meningitis

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