title: Heat exposure and bicycling trigger recurrent aseptic meningitis: a case report.
abstract: BACKGROUND
  Aseptic meningitis associated with herpes simplex virus type 2 often has a relapsing-remitting clinical phenotype. Factors that lead to disease activation and reactivation are currently incompletely understood.
  
  
  METHODS
  We describe the case of a 49-year-old Caucasian man who developed recurrent episodes of herpes simplex virus type 2-associated aseptic meningitis in the setting of heat exposure and bicycling. This case is compelling in that substantial data were available to the examining physicians on the amount of physical exercise and heat exposure. Strenuous physical activities or heat exposure in isolation did not cause re-occurrence of clinical signs and symptoms.
  
  
  CONCLUSIONS
  This case illustrates that the dual activation of mechanical and temperature receptors in dorsal root ganglia may lead to the recurrent reactivation and afferent dissemination of latent herpes simplex virus type 2 in some patients.
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. olaf.stuve@utsouthwestern.edu.|Neurology Section, VA North Texas Health Care System, Medical Service, 4500 South Lancaster Rd, Dallas, TX, 75216, USA. olaf.stuve@utsouthwestern.edu.|Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany. olaf.stuve@utsouthwestern.edu.|Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. olaf.stuve@utsouthwestern.edu.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stuve
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. ellenj.marder@va.gov.|Neurology Section, VA North Texas Health Care System, Medical Service, 4500 South Lancaster Rd, Dallas, TX, 75216, USA. ellenj.marder@va.gov.
authors.forename: Ellen
authors.initials: E
authors.lastname: Marder
authors.affiliation: Multiple Sclerosis Treatment Center of Dallas, Dallas, TX, USA. annette.okai@baylorhealth.edu.
authors.forename: Annette
authors.initials: A
authors.lastname: Okai
authors.affiliation: Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. Mark.Stettner@med.uni-duesseldorf.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Stettner
authors.affiliation: Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. bernd.kieseier@uni-duesseldorf.de.
authors.forename: Bernd C
authors.initials: BC
authors.lastname: Kieseier
mesh_terms: D001642:Bicycling; D015444:Exercise; D018882:Heat Stress Disorders / Q000150:complications*; D006561:Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification / Q000502:physiology*; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008582:Meningitis, Aseptic / Q000821:virology*; D008875:Middle Aged; D012008:Recurrence; D014775:Virus Activation / Q000502:physiology