Öz
Gastrointestinal sistem tutulumu, sistemik lupus eritematozus (SLE) hastalarında nadir olarak başlangıç bulgusu olabilir. Asitle başvuran bir SLE hastasında; SLE ile ilişkili olan lupus peritoniti, protein kaybettiren enteropati ve pseudo-pseudo Meigs sendromu (PPMS) gibi tanıların yanısıra, nefrotik sendrom, tüberküloz, kalp yetmezliği, konstriktif perikardit ve malignite gibi SLE dışı klinik durumlar da ayırıcı tanıya girmesi nedeniyle detaylı bir inceleme gereklidir. PPMS, SLE hastasında asit, yüksek CA-125 seviyeleri ve malignite dışlandıktan sonra tanı konan tartışmalı bir klinik durumdur. SLE’nin bu klinik tablolardan biriyle ortaya çıkabileceği unutulmamalıdır. Bu nedenle, SLE hastasında asit durumunda kesin tanı koymak zor olabilir. Bu yazıda, literatür verileri ışığında PPMS tanısının ilk belirtiden kesin tanıya kadar olan süreçte yaşanan zorlukları paylaşmayı amaçladık.
Anahtar Kelimeler: Sistemik lupus eritematoz, asit, erkek, psödo-psödo Meigs sendromu
Kaynakça
Kiriakidou M, Ching CL. Systemic Lupus Erythematosus. Ann Intern Med. 2020;172:ITC81-ITC96
Pramanik B. Diagnosis of systemic lupus erythematosus in an unusual presentation: what a primary care physician should know. Curr Rheumatol Rev. 2014;10:81-6.
Zhou L, Ming Sun C, Li Chen W, et al. Massive and painful ascites as a presenting manifestation of systemic lupus erythematosus flare: a case report and literature review. Rev Med Chil. 2014;142:255-60.
Ebert EC, Hagspiel KD. Gastrointestinal and hepatic manifestations of systemic lupus erythematosus. J Clin Gastroenterol. 2011;45:436-41.
Forouhar-Graff H, Dennis-Yawingu K, Parke A. Insidious onset of massive painless ascites as initial manifestation of systemic lupus erythematosus. Lupus. 2011;20:754-57.
Ong CS, Cheah TE, Jasmin R, et al. Painless ascites and elevated CA125: initial presentation of lupus-associated protein-losing enteropathy. Lupus. 2013;22:1174-7.
Gao F, Xu Y, Yang G. Pseudo-pseudo Meigs’ syndrome presenting with a combination of polyserositis, elevated serum CA 125 in systemic lupus erythematosus: A case report. Medicine (Baltimore). 2019;98:e15393.
Yang Z, Liang Y, Li C, Zhong R. Serum CA125 elevation is independently associated with serositis in SLE patients. Clin Exp Rheumatol. 2012;30:93-8.
Li T, Xie QB. A case report of pseudo-pseudo Meigs’ syndrome. Chin Med J (Engl). 2019;132:1497-98.
Tansir G, Kumar P, Pius A, et al. Pseudo-pseudo Meigs’ syndrome: a rare presentation of systemic lupus erythematosus. Reumatismo. 2019;71:108-12.
Lee SY, Lee SW, Chung WT. Severe inflammation may be caused by hyperferritinemia of pseudo-pseudo Meigs’ syndrome in lupus patients: two cases reports and a literature review. Clin Rheumatol. 2013;32:1823-26.
Cheah CK, Ramanujam S, Mohd Noor N, et al. A case of mixed connective tissue disease with pseudo-pseudo Meigs’ syndrome (PPMS)-like features. Lupus. 2016;25:214-6.
Dalvi SR, Yildirim R, Santoriello D, et al. Pseudo-pseudo Meigs’ syndrome in a patient with systemic lupus erythematosus. Lupus. 2012;21:1463-6.
Awad A, Essam M, Ezzat A, El Menyawi M. Systemic Lupus Erythematosus ith Lupus Nephritis Presented With Recurrent Massive Ascites: A Case of Pseudo-Pseudo Meigs Syndrome. Arch Rheumatol. 2019;34:243-4.
McVorran S, Song J, Pochineni V, et al. Systemic Lupus Erythematosus Presenting with Massive Ascites: A Case of Pseudo-Pseudo Meigs Syndrome. Case Rep Rheumatol. 2016;8701763.
Bes C, Soy M. Pseudo-pseudo Meigs syndrome developed under the leflunomide therapy. Rheumatol Int. 2011;31:521-23.
Bes C, Dağlı Ü, Memedoğlu P, et al. A rare form of SLE: pseudo-pseudo meigs syndrome and hydrocephalus. Rheumatol Int. 2013;33:2175-6.
Ural UM, Kiliç A, Güngör T, Ozdal B, Mollamahmutoğlu L. Tjalma’s or pseudo-pseudo-Meigs’ syndrome: a case report. Clin Exp Dermatol. 2008;33:363-4.
Zampeli E, Skopouli FN, Moutsopoulos HM. Polyserositis in a Patient with Active Systemic Lupus Erythematosus: A Case of Pseudo-pseudo Meigs Syndrome. J Rheumatol. 2018;45:877-8.
Ahmed O, Malley T, Kitchen J. A case of pseudo-pseudo Meigs’ syndrome. Oxf Med Case Reports. 2019;2019:omy136.
Horino T, Ogasawara M, Kashio T, et al. Lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs’ syndrome and successfully treated with hydroxychloroquine. Rom J Intern Med. 2022;60:85-9.
Meena DS, Kumar B, Gopalakrishnan M, et al. Pseudo-pseudo Meigs’ syndrome (PPMS) in chronic lupus peritonitis: a case report with review of literature. Mod Rheumatol Case Rep. 2021;5:300-5.
