Modern Rheumatology Case Reports

Pseudo–pseudo Meigs' syndrome (PPMS) in chronic lupus peritonitis: a case report with review of literature

Gastrointestinal involvement in systemic lupus erythematosus (SLE) usually occurs in the form of mesenteric vasculitis, protein-losing enteropathy, intestinal pseudo-obstruction, and pancreatitis. We describe a 23-year-old female, a known case of SLE presented with significant ascites and pleural effusion. Further evaluation showed elevated CA-125 levels without evidence of malignancy. The patient was treated with corticosteroids, hydroxychloroquine, and azathioprine resulting in the resolution of ascites in 2 weeks. The triad of ascites, pleural effusion, and increased CA-125 is known as pseudo-pseudo Meigs' syndrome, which is rarely reported in the literature. Clinicians should be aware of this entity while evaluating an SLE patient with low serum-ascites albumin gradient (SAAG) ascites.

Parallel course of calcinosis and cancer in a patient with anti-NXP2-positive dermatomyositis: A case report

ABSTRACT Background In patients with dermatomyositis (DM) and anti-nuclear matrix protein 2 autoantibodies, associations with both cancer and calcinosis are well established. However, the relationship between the progression of calcinosis and the development of cancer remains unknown. Herein, we describe a unique case that prompts hypotheses regarding shared immunologic mechanisms underlying these clinical complications. Case presentation We present the case of a 46-year-old woman diagnosed with biopsy-proven anti-nuclear matrix protein 2-positive DM manifesting as proximal muscle weakness, myalgias, pruritic rash, and elevations in creatine phosphokinase. Five years into her disease course, the patient developed an abrupt, coincident severe calcinosis and stage IIB squamous cell carcinoma of the cervix. She required aggressive immunosuppression, immunomodulation, and cancer therapy, which ultimately resulted in the remission of her cancer and improvement of her DM, with her calcinosis achieving a quiescent state. Her case describes a parallel course of calcinosis and cancer, and it highlights the challenges of managing refractory DM with malignancy. Conclusions Our case demonstrates that calcinosis and cancer can develop concurrently and follow a parallel course over time, suggesting a possible mechanistic link between the two complications. This report also highlights that communication between rheumatology, medical oncology, and radiation oncology is pivotal for optimally treating these complex patients.