Pseudo-pseudo Meigs’ syndrome in a patient with systemic lupus erythematosus

Abstract

Pseudo-pseudo Meigs' syndrome (PPMS) is a rare manifestation of patients with systemic lupus erythematosus (SLE), defined by the presence of ascites, pleural effusions and an elevated CA-125 level. We describe a patient with longstanding lupus who presented with localized lymphadenopathy and subsequently developed massive chylous ascites with marked hypoalbuminemia. A brief historical overview of Meigs' syndrome and related entities is presented, along with a discussion of the differential diagnosis of hypoalbuminemia and ascites in an SLE patient. In addition, we speculate on the optimal therapeutic intervention in such a patient.

Pseudo-pseudo Meigs’ syndrome in Rheumatology

“…Peritoneal and pleural fluids of the patients originally with MS were transudates [1]. In pseudo-MS similar features are due to other benign or malignant tumors; Pseudo Pseudo-MS (PPMS) occurs in Systemic Lupus Erythematosus (SLE) alone or SLE plus scleroderma [2][3][4][5][6]. The term PPMS was first utilized in 2005 by Schmitt et al, in the case report of a 33-year-old woman with the classical characteristics of the syndrome and enlarged cystic ovaries [2].…”

“…However, the abnormal cystic ovarian changes in this patient could indicate coexistent MS or PMS with active course of SLE in a young female with the tendency to multi-organ serositis. In fact, PPMS may be due to lupus phenotype characterized primarily by polyserositis [4]. The differential diagnosis of PPMS constitutes a challenging task mainly for non-specialists.…”

“…The differential diagnosis of PPMS constitutes a challenging task mainly for non-specialists. A major concern is about the interpretation of elevated levels of CA 125 described in patients with PPMS [2][3][4][5][6], because this tumor marker is considered indicative of ovarian malignancy. High levels of CA125 may be also due to pelvic tuberculosis and nephrotic syndrome [3,4].…”

“…PPMS is an exceeding uncommon condition diagnosed in rheumatologic patients, and the scarcely reported cases were associated with SLE, or SLE and scleroderma (MCTD) [2][3][4][5][6].…”

“…As benign and malignant ovarian tumors are more frequent than PPMS, one must rule out the typical MS and the PMS caused by ovarian malignancy that are more prevalent entities [1][2][3][4][5][6].…”