Page 31 - MRS Abstracts March 2023

Tjalma Syndrome as an initial presentation of SLE /case report
Introduction:
Rehab Mohammed , Rheumatology ST5 Behram Khan , Consultant Rheumatologist
Haywood Hospital, MPFT
Tjalama syndrome, also termed "pseudo-pseudo Meigs' syndrome," is an extremely rare manifestation of Systemic Lupus Erythematosus which can present with massive ascites, pleural/pericardial effusion and elevated CA-125 without an associated ovarian tumour. Only few cases have been reported in literature.
Case presentation:
A 53-year-old female presented with recurrent pleural and pericardial effusion. Initial symptoms included acute chest pain and elevated D-dimer, with CTPA revealing pericardial, pleural effusion and features of respiratory tract infection .
She received antibiotics which somewhat improved her symptoms. Subsequent echocardiography showed resolving pericardial effusion. Months later, she presented with shortness of breath, bilateral pleural effusion, ascites, and lower limb oedema.
CT and Ultrasound of the Thorax demonstrated a recurrence of pericardial and pleural effusion. Pleural tap revealed a non-exudative aspirate, and cultures were negative for tuberculosis and viral screen was negative. Cardiac MR showed no infiltrative lesion. Due to pericarditis symptoms, she was given a short course of Colchicine and this has led to significant improvement. Elevated CA125 levels prompted a CT TAP, revealing a possible uterine fibroid.
Subsequent investigations arranged by gynaecology team including hysteroscopy and endometrial biopsy which found Extensive gynaecological investigations found no evidence of benign or malignant lesions.