Recurrent benign lymphocytic (mollaret) meningitis in systemic lupus erythematosus

Abstract

Background: Aseptic meningitis is one of the most infrequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE) with multifactorial etiologies including medications such as nonsteroidal anti-inflammatory drugs, azathioprine, and trimethoprim-sulfamethoxasole, as well as viruses and malignancy. Recurrent aseptic meningitis in SLE is rare, and remains a diagnostic challenge.

Methods: We report a unique SLE patient with recurrent (10 episodes), benign (self-limited) lymphocytic aseptic meningitis, which suggests the diagnosis of Mollaret meningitis. There was no prior use of medications known to provoke meningitis. No infectious etiology was identified and chronic meningitis was not observed. The patient had spontaneous resolution of symptoms with no neurologic sequelae.

Conclusion: Recurrent benign lymphocytic aseptic meningitis is recognized in this SLE patient. We propose that noninfectious Mollaret meningitis be classified as a feature of neuropsychiatric SLE syndromes.