SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Pseudo-Pseudo Meigs Syndrome With Systemic Lupus Erythematosus

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This case report describes a rare presentation of systemic lupus erythematosus (SLE) called pseudo-pseudo Meigs syndrome (PPMS), also known as Tjalma syndrome. PPMS is defined by the combination of pleural effusions, ascites, and elevated CA-125 levels in the absence of an ovarian tumor, which can closely mimic gynecologic malignancy.<br /><br />The patient was a 26-year-old woman with a history of idiopathic thrombocytopenic purpura who presented with two months of progressive, painless abdominal distension and nausea. Examination showed massive ascites and decreased breath sounds at both lung bases. Laboratory studies revealed normocytic anemia, mild hyponatremia, elevated inflammatory markers, hypoalbuminemia, mildly increased creatinine, and elevated CA-125. Initial fluid studies from paracentesis were sterile and benign, and imaging showed moderate ascites, mild bilateral pleural effusions, and mild hepatomegaly without pelvic masses.<br /><br />Because of proteinuria, the patient underwent immunologic workup, which showed positive anti-Smith, anti-dsDNA, anti-SSA, and anti-RNP antibodies with low complement levels. Renal biopsy confirmed class V lupus nephritis. She was diagnosed with SLE presenting with PPMS.<br /><br />The patient improved after treatment with intravenous steroids and was discharged on steroids, mycophenolate mofetil, and hydroxychloroquine.<br /><br />This report emphasizes that PPMS can be an initial manifestation of SLE and may lead clinicians to suspect ovarian cancer or other pelvic pathology. Recognizing this syndrome is important to avoid unnecessary invasive testing and to begin timely immunosuppressive therapy for underlying lupus.

Asset Subtitle

Rabia Salman Mahfooz

Meta Tag

Author List Amita Jane Dsouza, Daniel Kim, Grant Patterson, Rabia Salman Mahfooz, Zunaira Shah

Category Clinical Vignettes

Concept Pseudo-pseudo Meigs Syndrome

Concept Systemic Lupus Erythematosus

Concept Cirrhotic Ascites

Concept Pleural Effusion

Concept Meigs Syndrome

Distinguished Non-Finalist

Presenter Organization HCA Houston Healthcare

Presenting Author Rabia Salman Mahfooz

Track Adult

Keywords

systemic lupus erythematosus

pseudo-pseudo Meigs syndrome

Tjalma syndrome

pleural effusion

ascites

elevated CA-125

lupus nephritis

anti-dsDNA antibodies

mycophenolate mofetil

hydroxychloroquine

Pseudo-pseudo Meigs Syndrome

Systemic Lupus Erythematosus

Cirrhotic Ascites

Pleural Effusion

Meigs Syndrome