Mollaret’s meningitis: causes, symptoms and treatment

Meningitis occurs when the meninges are inflamed or swollen. The meninges are made up of three layers of membranes that protect the brain and spinal cord.

Meningitis is often due to an infection. Aseptic meningitis is a catch-all term that refers to cases of meningitis caused by viruses, fungi, parasites, drugs, and cancer.

Mollaret’s meningitis is a rare type of aseptic meningitis that is most commonly caused by herpes simplex virus type 2 (HSV-2). It is usually recurrent, which means symptoms can come on suddenly, go away, and come back later.

Although Mollaret’s meningitis is often linked to a history of HSV-2, it is usually not contagious and is not linked to an active infection.

Symptoms of Mollaret’s meningitis are similar to other forms of meningitis, but are usually milder and go away on their own in about a week. These may include:

Mollaret’s meningitis does not appear to cause long-term complications or side effects.

A case study 2014 reported that a 48-year-old man who was diagnosed with Mollaret made a full recovery with no lasting effects from the disease.

Similarly, the authors of a 2020 case study of Mollaret’s disease in a 30-year-old woman identified no long-term effects. They said most of the time the symptoms resolve without neurological complications.

A 2021 review and case study describing an 83-year-old man with Mollaret’s disease came to the same conclusion. The authors reported no known neurological side effects after recovery.

That said, larger studies are needed to confirm the absence of complications.

To diagnose Mollaret’s meningitis, your doctor may ask you to describe your symptoms and medical history. They will then perform a physical examination.

When doctors suspect meningitis, they usually use a lumbar puncture (spinal tap) to determine if the cause is bacterial or aseptic. This procedure involves extracting a small amount of cerebrospinal fluid from your spine and testing for protein, glucose, and red and white blood cell levels, in addition to a bacterial culture.

Your doctor may also order additional diagnostic tests, including urine, blood, and imaging tests, to rule out other possible causes for your symptoms. A positive PCR test for HSV-2 can sometimes confirm a diagnosis of Mollaret’s meningitis.

There is no standard treatment for Mollaret’s meningitis.

A 2021 review recommends providing supportive care for symptoms such as fever and nausea. The authors indicated that antiviral treatment is not necessary, as the symptoms usually go away completely on their own.

But your doctor can still prescribe antivirals. Symptoms of Mollaret’s meningitis can sometimes resemble other more serious conditions, such as encephalitis.

Mollaret’s meningitis is extremely rare. Although it has been linked to HSV-2, only a tiny fraction of people with HSV-2 will develop Mollaret’s meningitis.

It is not clear if there are other risk factors linked to the development of Mollaret. Without further research, there is no known way to prevent it.

Does Mollaret’s meningitis disappear?

In all of the case reports described in this article, Mollaret went off on his own. A 2022 case report and literature review note that Mollaret’s symptoms last 5-7 days.

Is Mollaret’s meningitis contagious?

Mollaret’s meningitis is not contagious.

That said, it is often linked to HSV-2 or other viral infections. HSV-2 is spread through sexual contact with an HSV-2 positive person.

Being HSV-2 positive does not mean you will develop Mollaret’s disease or another type of meningitis. These complications are rare.

Is there a vaccine to protect against HSV-2?

A vaccine against HSV-2 is currently under development. If you are HSV-2 positive, medications are available to reduce your risk of transmitting the virus to others.

HSV-2 is not the only virus that can cause Mollaret’s disease. Other viruses that have been linked to Mollaret include:

Mollaret’s meningitis is a rare and recurrent form of aseptic meningitis. Its symptoms include fever and headache.

It can be difficult to diagnose because the symptoms can resemble other conditions. It usually goes away on its own without treatment, but can come back weeks or months later.

There is no clear link between COVID-19 vaccination and Mollaret, although there are a handful of reports of aseptic meningitis following COVID-19 vaccination. This rare but possible complication can be treated with antiviral medications.