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[Recurrent aseptic meningitis (Mollaret meningitis)--spontaneous and drug-induced origin]
A F Thilmann1, E Möbius, R R Thilmann
1Neurologische Klinik mit Klinischer Neurophysiologie, Alfried Krupp von Bohlen und Halbach Krankenhauses, Essen.
Abstract:
Since its initial description by Mollaret in 1944, the etiology of the chronic aseptic meningitis has remained unknown. This rare disease may cause diagnostic problems if bacterial or viral causes are suspected. A different form of aseptic meningitis may be seen following a variety of drug treatments, especially with non-steroidal anti-rheumatic drugs: In many reports since 1978, meningitic attacks following administration of ibuprofen have been reported. We describe two cases of Mollaret-Meningitis with certain specialities: one case shows clear encephalitic involvement with aphasia in all six attacks. In the other case, five meningitic attacks appeared spontaneously, while two were drug-induced: the first attack was seen after a lumbar myelography with lopamidol and one attack appeared two hours after oral administration of 400 mg ibuprofen. It is suggested that Mollaret-Meningitis is a special form of a drug-induced allergic reaction, the provoking agent of which remains unknown.
Insights
Mollaret-Meningitis, a chronic aseptic meningitis, remains enigmatic. Research suggests it may be a specific allergic reaction to unknown drug triggers, presenting diagnostic challenges.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Mollaret-Meningitis, a rare form of chronic aseptic meningitis, has an unknown etiology since its initial description in 1944.
- Diagnosis can be challenging, often leading to suspicion of bacterial or viral infections.
- Aseptic meningitis can also arise from drug treatments, particularly non-steroidal anti-rheumatic drugs (NSAIDs), with ibuprofen frequently implicated since 1978.
Observation:
- Two distinct cases of Mollaret-Meningitis are presented.
- Case 1 exhibited significant encephalitic involvement with aphasia during all six observed attacks.
- Case 2 presented with five spontaneous meningitic attacks and two drug-induced episodes, one following lumbar myelography with lopamidol and another after ibuprofen ingestion.
Findings:
- The study suggests Mollaret-Meningitis could represent a specific type of drug-induced allergic reaction.
- The exact causative agent or agents remain unidentified.
- The association with NSAIDs like ibuprofen and contrast agents like lopamidol is highlighted.
Implications:
- Further research is needed to elucidate the specific allergens involved in Mollaret-Meningitis.
- This understanding could lead to improved diagnostic strategies and preventative measures for patients.
- Recognizing the potential drug-induced nature of Mollaret-Meningitis is crucial for clinical management.