MEIGS SYNDROME PRESENTING AS A LYMPHOCYTIC EXUDATIVE PLEURAL EFFUSION

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Meigs syndrome is defined by the presence of a benign fibromatous ovarian tumor with associated pleural effusion and ascites that resolve once the tumor is resected. Current literature describes the pleural effusion as an exudate and occurring in conjuncture with ascites. However, characterization by cell differential is lacking. We report a patient with a unilateral lymphocytic pleural effusion as the presenting feature of Meigs syndrome. CASE PRESENTATION: The patient is a 34-year-old woman with history of asthma, tobacco use, and uterine fibroids who presented with progressive dyspnea on exertion with chest tightness and cough for 4 months. She denied fevers, chills, night sweats, or tuberculosis risk factors, and was treated for pneumonia 5 months prior to presentation. On exam, heart rate was 109 bpm, SpO2 100% on room air, and lung sounds were decreased at both bases. Chest x-ray revealed a moderate right pleural effusion, confirmed on chest CT which also noted small ascites that was not clinically apparent on exam. Thoracentesis removed 2.1L of a lymphocyte predominant exudative fluid (protein 5.3 g/dL, LDH 294 U/L, WBC 325 /UL, 41% lymphocytes, 29% neutrophils, 24% macrophages, RBC 160,000 /UL, ADA 7.6 U/L, bacterial and AFB culture negative, cytology negative; serum LDH 138 U/L, serum protein 6.9 g/dL). Patient did not follow up until she represented to pulmonary clinic 3 months later with recurrent dyspnea on exertion. Exam revealed dullness at the right base consistent with recurrent pleural effusion as well as significant abdominal distension with fluid wave. Repeat thoracentesis removed 1.5L of dark serosanginuous fluid, with WBC 329 /UL, 3% neutrophils, 47% lymphocytes, RBC 508,750 /UL and chemistries again consistent with an exudate. A malignancy work-up was pursued and revealed an 8.8 cm ovarian/adnexal mass consistent with a dermoid. She underwent a left salpingo-oophorectomy and drainage of 4L bloody ascites. Pathology revealed a mature cystic teratoma. The patient had rapid respiratory improvement post-operatively without evidence of recurrence in pleural effusion at follow up. Overall her presentation was consistent with Meigs syndrome. DISCUSSION: Existing data regarding Meigs syndrome is limited with lack of classification of pleural effusion by cell counts and types. Pleural effusion is speculated to result from ascites translocation across the diaphragm, however the small amount of ascites on initial presentation of this patient was not clinically apparent to help guide diagnosis. CONCLUSIONS: To our knowledge this is the first reported case of a lymphocyte predominant exudative effusion caused by Meigs syndrome and it is an example of pleural effusion as the presenting clinical finding in a Meigs syndrome patient. Meigs syndrome, although uncommon, should therefore be considered in the differential diagnosis for women with new lymphocytic exudative pleural effusion. Reference #1: Krenke R et al. Pleural Effusion in Meigs’ Syndrome – transudate or exudate? Systemic Review of the Literature. Medicine. 2015. 94 (49): e2114 DISCLOSURES: No relevant relationships by Kevin Kovitz, source=Web Response No relevant relationships by Mateo Tole, source=Web Response No relevant relationships by Christen Vagts, source=Web Response