13th August 2024

A 41-year-old man presents to A&E with a 1 day history of fevers, neck stiffness, headaches, double vision and photophobia

A 41-year-old man presents to A&E with a 1 day history of fevers, neck stiffness, headaches, double vision and photophobia. He reports that this is the 4th time he has experienced these symptoms in the last 5 years. He was fully investigated for these symptoms and each time diagnosed with viral meningitis and his symptoms self-resolved within a few days. On assessment, he has a temperature of 37.9 degrees Celsius. He is unable to flex his neck and will not let you shine a light into his eyes during the cranial nerve exam. A CT head is performed and does not show any intracranial abnormalities. He has a past medical history of a previous pneumothorax, anxiety, renal stones and is a current smoker. He denies any recent infections, rashes or weight loss and is usually well. He is sexually active with female partners and reports that he occasionally has unprotected sex. A lumbar puncture is performed and on PCR testing herpes simplex virus DNA is present in the CSF.

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