A CURIOUS CASE OF MEIGS-LIKE SYNDROME R Chan MD Department of Medicine, Louisiana State University Health Sciences Center, Lafayette, LA INTRODUCTION: Though it has long been a documented diagnosis, there are not many case reports involving Meigs syndrome. Defined as a benign ovarian tumor associated with ascites and pleural effusion, this syndrome must be considered once malignancy is ruled out. Even more rare is the association of Meigs syndrome with pericardial effusion. CASE: A 42-year-old female with recurring pleural effusions presented with a complaint of shortness of breath and tachycardia. On previous admissions for similar symptoms, she was noted to have moderate bilateral pleural effusions in the setting of community-acquired pneumonia. At that time, thoracentesis revealed exudative effusion, with reactive mesothelial and inflammatory cells, for which she underwent video-assisted thoracoscopy with chest tube placement and Talc pleurodesis. Additionally, Magnetic Resonance Imaging of the pelvis was significant for a 15mm right ovarian mass with mild ascites. CA-125 level was elevated (88) with negative autoimmune and infectious workup. The patient was started on Provera on discharge with plans for outpatient surgical intervention due to concern for endometriosis. On current presentation, Computed Tomography of the thorax without contrast showed reoccurrence of bilateral pleural effusions and new-onset pericardial effusion, confirmed by echocardiogram. Cardiology was consulted and a left and right heart catherization was performed without evidence of coronary obstruction or pericardial constriction. She then underwent a laparoscopic right salpingo-oophorectomy. Pathology was consistent with a paratubal cyst and no evidence of malignancy. Her symptoms improved post-operatively and eventually CA-125 normalized. She was discharged with close follow up with repeat chest x-rays confirming resolution of pericardial and pleural effusions. DISCUSSION: The presence of pericardial effusion in the setting of Meigs syndrome is extremely rare; our literature review revealed roughly three known cases. The diagnosis of Meigs syndrome in association with pericardial effusion is questionable. However, the resolution of the pericardial effusion following the removal of the ovarian mass does point to a link. In the setting of unexplained pericardial effusion, the possibility of Meigs Syndrome should be considered.
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