From the skin to the brain: a hint to diagnose herpes simplex virus type 2 meningitis

Abstract

Introduction. Herpes simplex virus type 2 (HSV-2) is recognized as one of the most common causes of aseptic meningitis, that is also а well-known complication of genital herpes. We report a case of recurrent HSV-2 meningitis without genital lesions, but with simultaneous skin lesions that were a clue for diagnosis. Case presentation. A 21-year-old man had two episodes of aseptic meningitis in 2019 and 2021, respectively. During both episodes, the neurological manifestations were preceded by recurrent herpetic skin lesions on the right arm. HSV-2 deoxyribonucleic acid (DNA) was detected in the spinal fluid only in the first episode. However, due to the possibility that the lesions and simultaneous episodes of meningitis were caused by HSV-2, systemic acyclovir was initiated. Each time, the treatment was followed by rapid symptoms’ resolution. After the second episode, the patient was put on indefinite suppressive therapy with valacyclovir. Conclusions. Recurrent skin lesions can suggest the probability of HSV-2 etiology of concomitant meningitis and justify the initiation of acyclovir. In all confirmed meningitis cases with HSV-2, counseling on this genital infection and the possibility of sexual spread should be considered.

Keywords

• herpes simplex virus type 2
• recurrent meningitis
• herpetic skin lesions