Pseudo-pseudo Meigs syndrome in a patient with overlap syndrome: A case report and literature review
Abstract
Rationale: Pseudo-pseudo Meigs syndrome (PPMS), characterized by pleural effusion, ascites, and elevated cancer antigen-125 (CA-125) levels, is a rare complication of autoimmune diseases, particularly of systemic lupus erythematosus-systemic sclerosis (SLE-SSc) overlap syndrome.
Patient concerns: A 39-year-old female presented with progressive symptoms, including finger swelling (since 13 years), skin hardening (since 10 years), bilateral second toe ulceration (since 3 months), and abdominal distention (since 1 month). During treatment for pulmonary arterial hypertension (PAH), she developed significant ascites with elevated CA-125 levels.
Diagnoses: Comprehensive clinical evaluation and laboratory tests confirmed SLE-SSc overlap syndrome. Subsequently, contrast-enhanced abdominal magnetic resonance imaging and multidisciplinary consultation established the diagnosis of PPMS, attributed to both active disease and possible medication effects.
Interventions: Management included optimization of immunosuppressive therapy and discontinuation of PAH medications (Sildenafil and Ambrisentan).
Outcomes: Complete resolution of ascites was achieved, and the patient maintains stable condition under regular outpatient follow-up.
Lessons: This case emphasizes the importance of considering PPMS in autoimmune disease patients with unexplained ascites and elevated CA-125 levels, while suggesting a potential association between PAH medications and PPMS development.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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