DOI: https://doi.org/10.22141/2312-413x.6.2.2018.131097

A clinical case of a combination of secondary headache with recurrent genital rash in an immunocompetent woman

I.L. Vysochyna, V.V. Mavrutenkov, Z.O. Chykarenko, O.A. Rositskaya, N.V. Zhukova

Abstract


Headache is one of the most common pathological conditions worldwide, taking into account that 45 % of the adult population has ever reported severe or disabling cephalgia. This interdisciplinary problem often requires participation of many specialists to perform comprehensive differential diagnosis and to choose the effective management. The article investigates one of the causes of the headache such as infections due to persistent viruses. The article presents a detailed clinical case of recurrent episodes of severe disabling headache in an immunocompetent female, which were accompanied by genital rash. Performed laboratory survey is discussed. Methods and efficacy of therapeutic approach during exacerbation episodes and long-term follow-up are described. The article presents international classification of primary and secondary causes of headache disorders according to the International Headache Society (2013). The spectrum of etiological causes of headache, which should be included into differential diagnosis is discussed. Attention is given to differentiation of headache as a presentation of infectious diseases, both intracranial and systemic. Considering the presented clinical case of recurrent episodes of severe headache associated with signs of genital rash, etiology of herpes simplex virus 1 + 2 is suggested. According to clinicians’ opinion, Mollaret meningitis was diagnosed in the discussed case. The article presents historical background of this diagnosis, pathogenic features of this disorder, diagnostic criteria of Mollaret meningitis, its relation to the group of benign recurrent aseptic meningitis, as well as outline of other reasons of benign meningitis. Recommended management of Mollaret meningitis and its efficacy are provided in the study. Differential diagnosis of recurrent episodes of headache should include a long list of causes and often requires collaboration of different specialists. The combination of recurrent pain of any localization, such as cephalalgia with neurologic or somatic pathology, includes herpes simplex virus 1 + 2 infection in the clinical and laboratory differential diagnosis. When establishing the diagnosis of recurrent aseptic meningitis, such as Mollaret meningitis, first line etiotropic drugs are derivatives of acyclovir unless another cause of serous meningitis is confirmed. The use of acyclovir derivatives with recurrent aseptic meningitis, including Mollaret meningitis, can be justified on the basis of clinical signs in cases when exact etiotropic confirmation is complicated. This therapy should be performed as a long-term suppressive chemotherapy, duration and efficacy of which should be established during further clinical evaluation, considering absence of headache relapses and other clinical presentations.

Keywords


headache; adults; differential diagnosis; Mollaret meningitis; management

Full Text:

PDF

References


Kallio-Laine K, Seppänen M, Kautiainen H, et al. Recurrent lymphocytic meningitis positive for herpes simplex virus type 2. Emerg Infect Dis. 2009 Jul;15(7):1119-22. doi: 10.3201/eid1507.080716.

Rolak LA. Neurology Secrets. 5th ed. Philadelphia, PA: Mosby Elsevier; 2008. 486 p.

Robbins MS, Grosberg BM, Lipton R, editors. Headache. UK: Wiley-Blackwell; 2013. 336p.

Scottish Intercollegiate Guidelines Network. Diagnosis and management of headache in adults - A national clinical guideline. 2008. Available from: http://www.sign.ac.uk/sign-107-diagnosis-and-management-of-headache-in-adults.html

Steiner TJ, Paemeleire K, Jensen R. European principles of management of common headache disorders in primary care. J Headache Pain. 2007 Oct;8 Suppl 1:S3-47. doi: 10.1007/s10194-007-0366-y.

Berger JR, Houff S. Neurological Complications of Herpes Simplex Virus Type 2 Infection. Arch Neurol. 2008 May;65(5):596-600. doi: 10.1001/archneur.65.5.596.

Gilbert DN, Saag MS. The Sanford Guide to Atimicrobal Therapy 2016. 46th ed. USA: Antimicrobial Therapy; 2016. 254 p.

Galdi AP. Benign recurrent aseptic meningitis (Mollaret’s meningitis). Arch Neurol. 1979 Oct;36(10):657-8.

Mollaret P. Recurrent benign endothelio-leukocytic meningitis. A new syndrome or a new disease? (Case reports). Revue Neurologique. 1944;76:657-658.

Azizul Hoque M, Chowdhury N, Hoque Z, Siddiqui NA, Islam R, Ahmad Q. Mollaret’s Meningitis: A Case Report and Review of the Literature. TAJ: Journal of Teachers Association. 2004;17 (1): 41-46. doi: 10.3329/taj.v17i1.3489.

Tedder DG, Ashley R, Tyler KL, Levin MJ. Herpes simplex virus infection as a cause of benign recurrent lymphocytic meningitis. Ann Intern Med. 1994 Sep 1;121(5):334-8.

Kallio-Laine K. Herpes Simplex Virus Infection, Pathological Pain and Recurrent Lymphocytic Meningitis. Helsinki: University of Helsinki; 2009. 83p.

Abou-Foul AK, Buhary TM, Gayed SL. Herpes simplex virus type 2-associated recurrent aseptic (Mollaret’s) meningitis in genitourinary medicine clinic: a case report. Int Med Case Rep J. 2014 Mar 3;7:31-3. doi: 10.2147/IMCRJ.S58377.

Shalabi M, Whitley RJ. Recurrent Benign Lymphocytic Meningitis. Clin Infect Dis. 2006 Nov 1;43(9):1194-7. doi: 10.1086/508281.

Mirakhur B, McKenna M. Recurrent Herpes Simplex Type 2 Virus (Mollaret) Meningitis. J Am Board Fam Pract. 2004 Jul-Aug;17(4):303-5.

Jarrin I, Sellier P, Lopes A, et al. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department. Medicine (Baltimore). 2016 Jan;95(2):e2372. doi: 10.1097/MD.0000000000002372.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658.




Copyright (c) 2018 ACTUAL INFECTOLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта