Pleural Effusion and Ascites in Systemic Lupus Erythematosus: A Rare Case of Pseudo-Pseudo Meigs' Syndrome

Abstract

Pseudo-pseudo Meigs' syndrome (PPMS), also known as Tjalma syndrome, is a rare manifestation of systemic lupus erythematosus (SLE) characterized by pleural effusion, ascites, and elevated cancer antigen 125 (CA-125) levels in the absence of ovarian tumors. We report the case of a 26-year-old woman who presented with dyspnea and pleuritic chest pain. On evaluation, she was found to have a left-sided pleural effusion. Further investigations confirmed SLE. Laboratory findings and imaging studies ruled out infectious and malignant causes, leading to a diagnosis of PPMS by exclusion. Treatment with prednisolone and hydroxychloroquine (HCQ) resulted in marked clinical and serological improvement, with complete resolution of the pleural effusion. Additionally, we discuss the key differences between Meigs' syndrome and PPMS and compare this case with others reported in the literature. In patients with SLE presenting with pleural effusion, ascites, and elevated CA-125 levels, PPMS should be suspected. Diagnosis involves ruling out infectious and malignant causes through fluid analysis and imaging studies. This condition usually responds well to immunosuppressive therapy.