HSV-2 Associated Meningitis Case: A Challenging Diagnosis in An Immunocompetent Woman

Yıl 2023, , 60 - 62, 13.11.2023

Buket Baddal , Aysegul Bostancı , Kaya Süer

https://doi.org/10.33706/jemcr.1278277

Öz

Herpes simplex virus type-2 (HSV-2) associated aseptic meningitis is rarely seen in healthy individuals. Herein, we report a rare case of meningitis, associated with HSV-2, without the presence of genital lesions. A healthy, 40-year-old female was presented to the emergency service with unremitting headache, vomiting and nausea. Her cerebrospinal fluid (CSF) revealed elevated protein level of 308,2 mg/dL, high leukocyte cell count of 1,118,000 cells/µL with 98% lymphocytes and 2% polymorphonuclear neutrophils (PMNs). The bacterial culture and gram staining of CSF were negative. Real-time quantitative polymerase chain reaction (RT-qPCR) CSF analysis indicated the presence of HSV-2. The cranial MRI revealed meningeal contrast enhancement. The patient was administered acyclovir for 10 days during her hospital stay and she was discharged without any neurological sequela. The patient has a history of herpes infection. This case report shows that HSV-2 meningitis can occur in immunocompetent individuals via re-activation and should always be considered by the clinicians even in the absence of genital lesions.

Anahtar Kelimeler

Herpes simplex virus type 2, meningitis, CSF, molecular testing

Kaynakça

• Zhu S, Viejo-Borbolla A. Pathogenesis and virulence of herpes simplex virus. Virulence. 2021;12(1):2670-2702.
• Omland LH, Vestergaard BF, Wandall JH. Herpes simplex virus type 2 infections of the central nervous system: A retrospective study of 49 patients. Scandinavian Journal of Infectious Diseases. 2008;40:59-62.
• Miller S, Mateen FJ, Aksamit Jr AJ. Herpes simplex virus 2 meningitis: a retrospective cohort study. Journal of NeuroVirology. 2013;19:166-71.
• Grinney M, Mohseni MM. Recurrent bening lymphocytic (Mollaret’s) meningitis due to herpes simplex virus type 2. Baylor University Medical Center Proceedings. 2022;35(6):820-821.
• Berger JR, Houff S. Neurological Complications of Herpes Simplex Virus Type 2 Infection. Archives of Neurology. 2008;65(5):596-600.
• Kadayakkara DK, Candelaria A, Kwak YE, Loeser C. Herpes Simplex Virus-2 Esophagitis in a Young Immunocompetent Adult. Case Reports in Gastrointestinal Medicine. 2016;2016:7603484.
• Chand S, Thapa S, Gautam K, Twayana AR, Laguio-Vila MR, Elsourbagy T. Bening Recurrent Aseptic Meningitis (Mollaret’s Meningitis) in an Elderley Male: A Case Report. Journal of Nepal Medical Association. 2021;59(241):916-918.
• Sherchan R, Shrestha J, Omotosho YB, Dyatlova N, Nepomuceno JS. Herpes Simplex Virus-2 Meningitis Masquerading as Pseudotumor Cerebri. Cureus. 2021; 13(6):1-5.
• Davies N, Tang J, Ward KN. Herpes simplex virus type 2 and recurrent meningits. Lancet. 2004;364:501-502.
• O’Sullivan CE, Aksamit AJ, Harrington JR, Harmnsen WS, Mitchell S, Patel R. Clinical Spectrum and Laboratory Characteristics Associated with Detection of Herpes Simplex Virus DNA in Cerebrospinal Fluid. Mayo Clinic Proceedings. 2003;78:1347-1352.