Pseudo-Pseudo Meigs’ Syndrome in a 40-Year-Old Woman Without a Prior Systemic Lupus Erythematosus Diagnosis

Pseudo-pseudo Meigs' syndrome (PPMS), also known as Tjalma syndrome, is an exceptionally rare condition marked by pleural effusion, ascites, and elevated CA-125 levels, usually in the context of systemic lupus erythematosus (SLE) without any associated ovarian tumors. We report the case of a 40-year-old woman who presented with a four-month history of fatigue, nausea, weight loss, abdominal pain, and pleural effusion. Initial diagnostic workup revealed ascites, elevated CA-125 levels, and pleural effusions, with no evidence of malignancy. Notably, the patient had no prior history of SLE. Comprehensive clinical, biological, and immunological evaluation eventually confirmed SLE, leading to a diagnosis of PPMS. The patient was treated with methylprednisolone and Plaquenil, with careful monitoring for potential complications. This case highlights the diagnostic challenges posed by PPMS, particularly in the absence of a prior SLE diagnosis. The unusual initial presentation underscores the importance of considering PPMS in differential diagnoses to avoid misdiagnosis and unnecessary invasive procedures. Early recognition and appropriate management are essential for optimizing patient outcomes in this rare and complex syndrome.