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• W2798742047 abstract "Correspondence to: Dr Zaw Min, Department of Medicine, Division of Infectious Diseases, Allegheny General Hospital, Allegheny Health Network, 420 East North Avenue, East Wing, Suite 407, Pittsburgh, PA 15212, USA zmin@wpahs.org A 48-year-old man presented with a 2 day history of fever, headache, chills, neck stiff ness, and nausea and vomiting. He had a history of two episodes of viral meningitis, which occurred 30 and 13 years before this presentation. An examination confi rmed meningism without focal neurological defi cits. Results of CSF tests showed protein concentration of 120 mg/dL (normal 12–60 mg/dL), normal glucose concentration, red blood cells 26 cells/μL, and white blood cells 327 cells/μL (10% neutrophils, 84% lymphocytes, 6% monocytes). CSF Gram stain and cultures were negative. Diff -Quik stain of CSF showed many large activated monocytes with several deep nuclear clefts visible as so-called cloverleaf nucleus (green arrowhead, fi gure A), footprintshaped nucleus (white arrowhead, fi gure B), and beanshaped nucleus (green arrow, fi gure C), with a background of normal monocytes (black arrowheads, fi gure A, B) and lymphocytes (black arrows, fi gure A, B). The features of these activated monocytes were compatible with those of Mollaret’s cells, and CSF herpes simplex virus type 2 (HSV2) PCR assay was positive. Large degenerated monocytes were present as ghost cells (asterisks, fi gure B), observed in the slide background. A diagnosis of Mollaret’s meningitis was made. The patient was discharged without antimicrobial therapy and recovered completely. Mollaret’s meningitis was fi rst described by the French neurologist Pierre Mollaret in 1944. The disease is characterised by recurrent (at least three episodes), benign (no long-term sequelae) and brief (2–5 day) episodes of aseptic lymphocytic meningitis, alternating with symptom-free interval, mostly caused by HSV2 infection. The disease is usually self-limited, and antiviral therapy is routinely not recommended. It is therefore also known as recurrent benign lymphocytic meningitis. Typically, results of CSF studies show hypercellularity and predominantly lymphocytic pleocytosis with positive HSV2 DNA by PCR assay. Cellular cytomorphological features of CSF charac teristically show diagnostic Mollaret’s cells, which are multiple activated large monocytes with deep nuclear clefts giving rise to various convoluted, eye-catching shapes of nuclei, such as cloverleaf, bean, and footprint patterns. Usually degenerated monocytes known as ghost cells are present, scattered at the background of the slide. Recognition of these cells in the CSF is crucial for a timely and accurate diagnosis because it could prevent extensive and costly diagnostic studies and antimicrobial therapies." @default.
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• W2798742047 date "2014-01-01" @default.
• W2798742047 modified "2023-09-27" @default.
• W2798742047 title "Clinical Picture Mollaret’s meningitis" @default.
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