869 - Recurrent Mollaret's Meningitis Complicated by Idiopathic Intracranial Hypertension

A 46-year-old woman presented with severe headache, neck stiffness, photophobia, nausea, difficulty walking, and generalized weakness in her extremities. She has a complex history of recurrent viral meningitis, idiopathic intracranial hypertension (IIH), chronic headaches s/p ventriculoperitoneal (VP) shunt, anxiety, and depression. She has a history of ten viral meningitis episodes, mostly linked to HSV-2, and one episode of bacterial meningitis leading to neurological deficits including left-sided weakness and facial drooping. During this admission, neurological examination was positive for kernig sign, brudzinski sign, and weakness in her extremities. Lumbar puncture revealed significant lymphocytic pleocytosis with elevated protein and mildly reduced glucose. She was treated empirically with ceftriaxone, vancomycin, ampicillin, and acyclovir, which was later transitioned to valacyclovir after CSF studies were positive for HSV-2. During this hospitalization, she required multidisciplinary management, including specialists in infectious disease, neurology, neurosurgery, nutrition, and physical therapy to address her medical and functional impairments.

Discussions:

This case highlights the multifaceted challenges in managing Mollaret’s meningitis, particularly when complicated by IIH and chronic neurological conditions. Although Mollaret’s meningitis is typically self-limiting, the recurrence of meningitis in the context of IIH and VP shunt necessitates a comprehensive approach that integrates acute medical management with rehabilitation to prevent long-term disability. The patient’s ongoing functional limitations, including gait disturbances and chronic pain, underscore the critical role of rehabilitation in improving her quality of life.

Conclusions:

Recurrent Mollaret’s meningitis, particularly in the presence of comorbid conditions such as IIH, requires a multidisciplinary approach that includes both acute management and long-term rehabilitation strategies. Early recognition, prompt antiviral therapy, and targeted rehabilitation interventions are essential to mitigate the long-term functional impacts and improve patient outcomes.