Polyserositis in a Patient with Active Systemic Lupus Erythematosus: A Case of Pseudo-pseudo Meigs Syndrome

A 40-year-old woman was diagnosed with systemic lupus erythematosus (SLE) 10 years ago, manifesting with edematous hands, Raynaud phenomenon, livedo reticularis, arthralgias/arthritis of hand joints, and lymphadenopathy, without renal involvement. Laboratory and serological findings included chronic disease anemia, leukopenia, and diffuse hypergammaglobulinemia; positive antinuclear, anti-Sm, anti-Ro (Ro52 and Ro60), and increased anti-dsDNA antibodies; and hypocomplementemia. For the last 2 years, she was in remission under methylprednisolone 4 mg/day, azathioprine 100 mg/day, and hydroxychloroquine 200 mg/day. Two months before presentation, feeling inundated by the chronicity of her disease and treatment, she discontinued all medication. Upon presentation, she was unwell and dyspneic, and had intense livedo of lower extremities, Raynaud phenomenon, edematous hands with arthritis, and a distended abdomen. Breathing sounds of the left lung base were reduced. There was no pericardial friction rub or pulsus paradoxus, and echocardiography revealed a nonhemodynamically relevant pericardial effusion. Chest and abdominal computed tomography showed, in addition to the pericardial effusion, a unilateral pleural effusion (Figure 1A) and massive ascites (Figure 1B). Remarkable laboratory tests included elevated C-reactive protein [CRP; 30 mg/l, normal value (nv) < 5 mg/l], diffuse … Address correspondence to Dr. E. Zampeli, Institute for Autoimmune Systemic and Neurological Disorders, M. Asias 75, 11527, Athens, Greece. E-mail: zampelieva{at}gmail.com