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. 2024 Jan;31(1):e16081.
doi: 10.1111/ene.16081. Epub 2023 Oct 5.

Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark: a nationwide cohort study

Pelle Trier Petersen  1   2 , Jacob Bodilsen  3   4 , Micha Phill Grønholm Jepsen  1 , Birgitte Rønde Hansen  5 , Merete Storgaard  6 , Lykke Larsen  7 , Jannik Helweg-Larsen  8 , Lothar Wiese  9 , Hans Rudolf Lüttichau  10 , Christian Østergaard Andersen  11 , Trine Hyrup Mogensen  6   12 , Henrik Nielsen  3   4 , Christian Thomas Brandt  9 ; Danish Study Group of Infections of the Brain (DASGIB)
Affiliations

Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark: a nationwide cohort study

Pelle Trier Petersen et al. Eur J Neurol. 2024 Jan.

Abstract

Background and purpose: Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited.

Methods: This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison.

Results: Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis.

Conclusions: Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.

Keywords: aciclovir; aseptic meningitis; herpes simplex virus type 2; viral meningitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Cerebrospinal fluid leukocyte counts in adults with benign recurrent lymphocytic meningitis and single‐episode herpes simplex virus type 2 meningitis (a) and by the number of previous episodes of meningitis (b).
FIGURE 2
FIGURE 2
Unfavourable functional outcomes (Glasgow Outcome Scale scores of 1–4) by time after discharge in adults with benign recurrent lymphocytic meningitis and single‐episode herpes simplex virus type 2 meningitis.
FIGURE 3
FIGURE 3
Kaplan–Meier curve for additional recurrences of meningitis in adults with benign recurrent lymphocytic meningitis.
See this image and copyright information in PMC

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