Mollaret's Meningitis

Early in the morning on Monday (when I had been awake for 24 hours already and had another seven left to go before I went to bed), we had a new patient come in through the ED with viral meningitis. When we went through her old ED records, we found out that this was her fourth hospitalization for viral meningitis, which we thought was a bit odd. So we searched online and discovered a disease called Mollaret's meningitis, which is recurrent aseptic (non-bacterial) meningitis, most often caused by HSV-2 (the herpes virus that causes genital herpes; HSV-1 is cold sores). Interesting enough, most people with Mollaret's meningitis report never having genital herpes. So we sent her CSF (cerebrospinal fluid, from the lumbar puncture) to the lab to be tested for HSV-2. It's a test that takes a couple of days to come back, so we didn't have an answer yet when we discharged her today. Well, it came back positive this evening, which confirms Mollaret's. No treatment is required, since it's a self-limiting course (translation: lasts 2 days with treatment and 2 days without), but since this is her fourth hospitalization for viral meningitis, my attending is going to call her in a prescription for Valtrex (herpes medicine; you might recognize it from the commercials: "I have genital herpes." "And I don't." "And now we're doing something about it." etc).

So that was my fun discovery for the day (and since I was the one who told my attending that we should check for HSV-2 to see if this is Mollaret's, I now look really impressive). It's pretty rare, so it's kinda cool that now I can say that I've seen it.