Herpes Simplex Virus Type 1 DNA in Cerebrospinal Fluid of a Patient with Mollaret's Meningitis

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Abstract
MOLLARET'S meningitis is a rare disease characterized by recurrent, self-limited episodes of aseptic meningitis.1 Signs and symptoms of meningeal irritation appear acutely, in association with fever and pleocytosis of mononuclear cells. These episodes last two to five days or occasionally longer and remit spontaneously.2 6 Five to 15 attacks may occur, separated by symptom-free intervals of weeks to months. Transient neurologic abnormalities may be present during the attacks, but they disappear after the acute illness. The diagnosis of Mollaret's meningitis is made only after other recognized causes of recurrent lymphocytic meningitis have been excluded.2 Numerous attempts to establish a microbiologic cause for Mollaret's meningitis have failed,2 , 4 7 although herpes simplex virus (HSV) has been isolated from cerebrospinal fluid in a single case.3 We describe a patient who was experiencing her ninth episode of unexplained aseptic meningitis. During the first three days of the illness, her cerebrospinal fluid contained both HSV type 1 (HSV-1) DNA, as detected by polymerase-chain-reaction (PCR) amplification, and HSV-1 antibodies, as detected by immunoblot analysis.