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Li Q, Tian B. Case report: Three cases of systemic lupus erythematosus presenting primarily with massive ascites and significantly elevated CA-125 levels and a review of pseudo-pseudo Meigs' syndrome in literature. Front Immunol 2024; 15:1423631. [PMID: 39081322 PMCID: PMC11286392 DOI: 10.3389/fimmu.2024.1423631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
This article presents three detailed case reports and a brief review of the literature on a rare manifestation of systemic lupus erythematosus (SLE) known as Pseudo-Pseudo Meigs' Syndrome (PPMS). The patients' condition was characterized by elevated CA-125 levels, massive ascites andpleural effusion which is typically associated with ovarian malignancies but can also present in various non-malignant conditions, including SLE. A thorough literature review was conducted, summarizing similar cases and their clinical outcomes to provide a broader understanding of this uncommon syndrome. The findings emphasize the need for heightened awareness and consideration of pseudo-pseudo Meigs' syndrome in patients with SLE presenting with unexplained ascites and pleural effusion.
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Affiliation(s)
- Qiyu Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bailing Tian
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Wang JD, Yang YF, Zhang XF, Huang J. Systemic lupus erythematosus presenting with progressive massive ascites and CA-125 elevation indicating Tjalma syndrome? A case report. World J Clin Cases 2022; 10:9447-9453. [PMID: 36159442 PMCID: PMC9477686 DOI: 10.12998/wjcc.v10.i26.9447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/06/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ascites, pleural effusion and raised CA-125 in the absence of malignancy in systemic lupus erythematosus is known as Tjalma syndrome.
CASE SUMMARY We report a special case of a systemic lupus erythematosus patient presenting with Tjalma syndrome. She presented with ascites and elevated CA-125 in the absence of benign or malignant ovarian tumor and no pleural effusions, which is an unusual presentation for this rare condition.
CONCLUSION Tjalma syndrome can present with massive ascites alone without pleural or pericardial effusions.
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Affiliation(s)
- Jun-Di Wang
- Department of Rheumatic Disease, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yan-Fei Yang
- Department of Respiratory Disease, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xian-Feng Zhang
- Department of Rheumatic Disease, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jiao Huang
- Department of Rheumatic Disease, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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Chao YH, Chen HY. Rare cause of ascites and pleural effusion: The first case report and literature review of pseudo-pseudo Meig's syndrome in Taiwan. J Formos Med Assoc 2022; 121:2633-2638. [PMID: 35459608 DOI: 10.1016/j.jfma.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
Pseudo-pseudo Meigs' syndrome (PPMS) exhibits patients with ascites, pleural effusion, elevated CA-125, and diagnosed of systemic lupus erythematosus (SLE) eventually without evidence of ovarian or pelvic tumor. It's a rare diagnosis but it has a good response to treatment. We here present an 82-year-old female, who was found to have ascites, pleural effusion, and elevated CA-125. CT of abdomen revealed absence of pelvic tumor. However, a rapid decline in renal function and progressive proteinuria were also observed. We performed an autoimmune-associated investigation. A diagnosis of late-onset SLE was made due to meeting the criteria of serositis, hemolytic anemia, thrombocytopenia, renal disease, and positive anti-smith antibody. We gave this patient a regimen with steroids and hydroxychloroquine. Both ascites and pleural effusion resolved in one month. PPMS is an important differential diagnosis in female patients with ascites, pleural effusion, and elevated CA-125. A survey of the pelvic tumor should be done first to exclude Meigs' syndrome or pseudo-Meigs' syndrome. SLE flare-up should be kept in mind even in the elderly.
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Affiliation(s)
- Yi-Hsiang Chao
- Department of Surgery, Kaohsiung Veteran General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 813, Kaohsiung, Taiwan.
| | - Hsin-Yu Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan.
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Meena DS, Kumar B, Gopalakrishnan M, Kachhwaha A, Kumar S, Sureka B, Gupta S, Bohra GK, Garg MK. Pseudo-pseudo Meigs' syndrome (PPMS) in chronic lupus peritonitis: a case report with review of literature. Mod Rheumatol Case Rep 2021; 5:300-305. [PMID: 33970813 DOI: 10.1080/24725625.2021.1916160] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Gastrointestinal involvement in systemic lupus erythematosus (SLE) usually occurs in the form of mesenteric vasculitis, protein-losing enteropathy, intestinal pseudo-obstruction, and pancreatitis. We describe a 23-year-old female, a known case of SLE presented with significant ascites and pleural effusion. Further evaluation showed elevated CA-125 levels without evidence of malignancy. The patient was treated with corticosteroids, hydroxychloroquine, and azathioprine resulting in the resolution of ascites in 2 weeks. The triad of ascites, pleural effusion, and increased CA-125 is known as pseudo-pseudo Meigs' syndrome, which is rarely reported in the literature. Clinicians should be aware of this entity while evaluating an SLE patient with low serum-ascites albumin gradient (SAAG) ascites.
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Affiliation(s)
- Durga Shankar Meena
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Bharat Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Maya Gopalakrishnan
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Arjun Kachhwaha
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shruti Gupta
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Krishana Bohra
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Quintero-Muñoz E, Gómez Pineda MA, Araque Parra C, Vallejo Castillo CA, Ortega Marrugo V, Bonilla Jassir J, Polo Nieto JF, Parra-Medina R, Rojas-Villarraga A. Is there any relationship between massive ascites and elevated CA-125 in systemic lupus erythematosus? Case report and review of the literature. Mod Rheumatol Case Rep 2021; 5:292-299. [PMID: 33783326 DOI: 10.1080/24725625.2021.1909213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease of variable presentation. Massive ascites in the context of SLE is infrequent. Even so, it has been reported that ascites may be the first manifestation of SLE. It is difficult to diagnose due to the multiple possible aetiological causes of ascites. There is a rare entity called Pseudo-Pseudo Meigs Syndrome (PPMS) in patients with SLE who have ascites, pleural effusion, and CA-125 elevation unrelated to malignancy. We present two cases of massive ascites, pleural effusion and elevation of CA-125 with a history of SLE diagnosis. One of these cases was diagnosed with PPMS and another associated with neoplasm of ovarian origin.
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Affiliation(s)
- Elias Quintero-Muñoz
- Research Division, Fundación Universitaria de Ciencia de la Salud (FUCS), Bogotá, Colombia
| | | | - Carolina Araque Parra
- Internal Medicine Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud (FUCS), Bogotá, Colombia
| | - Camilo Alfonso Vallejo Castillo
- Internal Medicine Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud (FUCS), Bogotá, Colombia
| | - Víctor Ortega Marrugo
- Radiology Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud, Bogotá, Colombia
| | - Juan Bonilla Jassir
- Pathology Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud, Bogotá, Colombia
| | - José Fernando Polo Nieto
- Pathology Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud, Bogotá, Colombia
| | - Rafael Parra-Medina
- Pathology Department, Hospital Infantil Universitario de San José. Fundación Universitaria de Ciencia de la Salud, Bogotá, Colombia
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Adlan AS, Chua PT, Huang KG. Laparoscopic Resection of a Subserosal Leiomyoma Presenting as Pseudo–Meigs' Syndrome. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aizura-Syafinaz Adlan
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Teng Chua
- Department of Obstetrics and Gynaecology, Mahkota Medical Centre, Melaka, Malaysia
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkouter Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkouter Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
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