An exceptional case of sudden death due to pseudo‐Meigs syndrome

Pseudo-Meigs syndrome is a rare clinical entity characterized by the triad of ascites, pleural effusion, and a benign pelvic tumor other than an ovarian fibroma. Although typically considered benign and reversible following tumor removal, the syndrome can result in severe life-threatening compromise if unrecognized or untreated. Unlike the classical Meigs syndrome, which has occasionally been associated with fatal outcomes, no deaths related to pseudo-Meigs syndrome due to benign tumors have been previously reported. This report presents the sudden death of a young adult woman who complained of acute shortness of breath and died shortly thereafter. Postmortem examination revealed more than 2.5 L of serous fluid within the thoracic and abdominal cavities, severe pulmonary collapse, and a markedly enlarged uterus containing a large leiomyoma. Histologic evaluation confirmed the tumor as a uterine leiomyoma. The findings observed at autopsy account for the proposed pathophysiologic mechanisms of death, in which impaired gas exchange and increased intrathoracic pressure likely compromised cardiac output, leading to death. These findings support a diagnosis of pseudo-Meigs syndrome with fatal cardiopulmonary consequences. This case represents the first fatality attributed to pseudo-Meigs syndrome associated with a benign tumor. Awareness of this potential outcome is essential for both clinicians and forensic pathologists when evaluating individuals with large benign pelvic tumors and unexplained cavity effusions.