Case report: A 17-year-old male with chronic constipation presented to the emergency department for urinary retention of 2 days duration. He endorsed the sensation to void with an inability to empty his bladder despite straining in the setting of a two-week history of mild headaches, diffuse back pain, myalgias and low-grade fevers. He was non-toxic appearing and neurological exam was normal. Abdominal X-ray showed a moderate stool burden. Spine MRI demonstrated subtle enhancement of the cauda equina. CSF evaluation were notable for an elevated opening pressure to 34 mmHg and a lymphocytic pleocytosis (693 white blood cells), and elevated protein of 60. Multiplex panel for central nervous system infections by polymerase chain reaction was positive for HSV-2. He was admitted to the hospital for IV acyclovir and management of urinary retention.  

This case demonstrated the importance of keeping meningitis retention syndrome on the differential for individuals presenting with acute urinary retention after a viral infection. Keeping a high index of suspicion is crucial, especially in cases like the one described where the patient only had some vague viral symptoms but no obvious meningeal signs, radicular pains or genital ulcers.