A Case of Tjalma Syndrome Coincidentally Accompanied by an Ovarian Teratoma Successfully Treated with Intravenous Immunoglobulin-G Adjunctive Therapy

Eun-Kyoung Park; Seung-Geun Lee; Ik Soo Byon; Sun-Hee Lee; Seong-Jun Lee; Yoon-Jeong Nam; Ji-Hye Park; Geun-Tae Kim; Young-Eun Park; Seong-Hu Park; Joung-Wook Lee; Jun-Hee Lee; Seung-Hoon Baek

doi:10.4078/jrd.2014.21.2.77

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Park, Lee, Byon, Lee, Lee, Nam, Park, Kim, Park, Park, Lee, Lee, and Baek: A Case of Tjalma Syndrome Coincidentally Accompanied by an Ovarian Teratoma Successfully Treated with Intravenous Immunoglobulin-G Adjunctive Therapy

Case Report

J Rheum Dis 2014;21(2):77-81.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.2.77

A Case of Tjalma Syndrome Coincidentally Accompanied by an Ovarian Teratoma Successfully Treated with Intravenous Immunoglobulin-G Adjunctive Therapy

Eun-Kyoung Park¹, Seung-Geun Lee¹, Ik Soo Byon², Sun-Hee Lee¹, Seong-Jun Lee¹, Yoon-Jeong Nam¹, Ji-Hye Park¹, Geun-Tae Kim³, Young-Eun Park⁴, Seong-Hu Park⁵, Joung-Wook Lee⁶, Jun-Hee Lee⁷, Seung-Hoon Baek⁷

¹Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

²Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

³Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

⁴Malgeunsem Hospital, Busan, Korea

⁵Changwon, Young-do Hospital, Busan, Korea

⁶Busan St. Mary's Medical Center, Busan, Korea

⁷Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea

Corresponding to: Seung-Geun Lee, Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, Korea. E-mail: sglee@pnuh.co.kr

Received 22 April 2013 Revised 16 June 2013 Accepted 17 June 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tjalma or pseudo-pseudo Meigs' syndrome is a clinical condition that is characterized with ascites, pleural effusion, and increased serum CA-125 levels in patients with systemic lupus erythematosus (SLE) without the presence of ovarian tumor. On the other hand, Meigs' and pseudo-Meigs' syndromes represent the same manifestations with ovarian tumor. In this case report, we present a 43-year-old SLE patient suffering from Tjalma syndrome with the coexistence of incidental ovarian teratoma, who was successfully treated with intravenous immunoglobulin-G adjunctive therapy after inadequate response to surgical excision of the ovarian tumor, steroid, and cyclophosphamide pulse therapy.

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Keywords: Systemic lupus erythematosus, Intravenous immunoglobulin, Ascites, Pleural effusion

REFERENCES

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Figure 1.

Chest radiograph showing right pleural effusion (arrow).

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Figure 2.

Abdominal computed tomography showing ascites (arrowhead in A) and 4.3 cm sized ovarian tumor (arrow in B).

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Table 1.

Changes in serum CA-125 and albumin concentrations according to therapy

Day	0	98	102	109	141	143	148	150	154	156	162	178	197
Serum albumin (mg/dL)	1.4	1.5		1.5	1.8			1.6	1.5		2	3.4	3.8
Serum CA-125 (U/mL)	544.4	2,266		1,910	2,951			2,783			1,710	455.1	33.6
Treatment			Oophorectomy			MPT for 3 days	Cyclophosphamide			IVIG for 5 days

MPT: methylprednisolone pulse therapy, IVIG: intravenous immunoglobulin-G.

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