Herpes simplex meningitis presenting as headache in pregnancy: A case report

Area of Science:

• Neurology
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Herpes simplex virus (HSV) meningitis is an uncommon obstetric complication.
• Pregnancy management and delivery planning are complicated by HSV meningitis presentation.

Observation:

• A 35-year-old pregnant patient presented with severe headache, initially suspected as a systemic lupus erythematosus (SLE) flare.
• Neurological symptoms and lumbar puncture results confirmed HSV-2 meningitis, despite no prior HSV diagnosis.
• The patient received intravenous acyclovir, responded well, and was discharged on oral antiviral therapy.

Findings:

• HSV-2 IgG positive and unspecified HSV IgM titer confirmed recurrent HSV meningitis.
• Treatment with intravenous acyclovir led to significant clinical improvement.
• Vaginal delivery was deemed safe after multidisciplinary consultation, though the patient opted for cesarean delivery.

Implications:

• Unrelenting headaches in pregnant patients warrant high suspicion for meningitis, irrespective of HSV history.
• Early diagnosis and antiviral treatment are vital for managing HSV meningitis in pregnancy.
• Multidisciplinary collaboration is essential for optimizing pregnancy and delivery management in such cases.