Malignant Pseudo-Meigs Syndrome Presenting as Recurrent Eosinophilic Pleural Effusion

Abstract

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Pseudo-Meigs’ syndrome is a clinical syndrome where pleural effusion (PEf) and/or ascites are associated with ovarian tumor other than fibroma. We report a challenging case of pseudo-Meigs’ syndrome associated with ovarian mucinous carcinoma in a patient with recurrent right-sided exudative, eosinophilic PEf without cytologic evidence of malignancy in effusion. CASE PRESENTATION: A 51-year-old woman with a history of chronic lymphedema and venous stasis was admitted to the hospital for acute hypoxemic respiratory failure presenting with shortness of breath for 24 hours. On examination, she was in respiratory distress. Her temperature was 38.1°C; pulse 114 beats/minute; respiratory rate 22 breaths/minute; and oxygen saturation 93% breathing 3L/minute of supplemental oxygen through nasal cannula. Auscultation of the chest revealed crackles in her lower lung fields, pronounced on the right. Laboratory findings include white blood cells 19,500/mm3, erythrocyte sedimentation rate 130 mm/hour, and creatinine kinase 18 U/L. Computed tomography (CT) of the chest showed a large right-sided PEf. 900 mL of exudative fluid was drained by thoracentesis with improvement of symptoms. PEf was remarkable for eosinophilia (17%) with no malignant cells. On day 2 of hospitalization, her shortness of breath recurred. Chest radiograph showed recurrent right sided PEf. Another thoracentesis drained 1000 ml of eosinophilic effusion with no malignant cells. Repeat CT showed no underlying lung pathology. 48 hours later, her symptoms worsened and chest radiograph showed right sided PEf for the third time. Given the recurrent effusion with persistent negative cytology, CT of the abdomen was performed for a possible underlying malignancy. This revealed a large multiloculated cystic pelvic mass extending into the abdomen with omental caking and/or peritoneal carcinomatosis and lymph node involvement. Her labs then revealed CA 125 of 78 U/mL and CEA of 4.8 ng/mL. A debulking surgery was performed, revealing a 27x25x20cm ovarian mucinous carcinoma, histologic type G2: moderately differentiated without other organ involvement. Peritoneal ascetic fluid and lymph nodes were negative for malignancy. Three days later, 1000mL was drained via thoracentesis with cytology negative for malignant cells. 17 days later, follow up chest radiograph showed persistent effusion, however the fourth thoracentesis drained only 150 cc, and she remained asymptomatic. DISCUSSION: Recurrent right-sided exudative eosinophilic PEf, even without the presence of malignant cells, may be a marker for underlying malignancy when no obvious lung pathology is found. CONCLUSIONS: Ruling out an underlying malignant tumor, is essential as this could be from pseudo-Meig’s syndrome as seen in our case. Reference #1: Pleural Effusion in Meigs' Syndrome-Transudate or Exudate?: Systematic Review of the Literature. Krenke R, Maskey-Warzechowska M, Korczynski P, Zielinska-Krawczyk M, Klimiuk J, Chazan R, Light RW. Medicine. 12/2015 DISCLOSURE: The following authors have nothing to disclose: Reema Qureshi, Anna Hilton, Humnah Khudayar, Somwail Rasla, Taro Minami No Product/Research Disclosure Information