POMR 9

A 42-year-old woman with

Pseudo Meigs’ Syndrome

Hariogie Putradi

Moderator: dr. Anik Widijanti, Sp. PK (K)

DATA BASE
Female, 42 year old.
Admitted on March 30th, 2018.

 Chief complaint: Patient suffered from

shortness of breath.

 History of present illness:

˗ Patient suffered from shortness of breath since
4 days ago.
˗ She has also got diarrhea since 5 days ago,
frequency 7 times per day.
˗ She also has vomiting 7 times per day
containing food and water.
DATA BASE
˗ She had no fever.
˗ Urination were normal.
 History of past illness:
- She had been diagnosed with ovarian cancer
since 4 months ago. She also had been
operated 2 months ago and got chemotherapy
5 times (carboplastin and paclitaxel). History of
transfusion: PRC 2 packs,TC 1 pack (25/03/2018)
 History of family disease:
- No history.
 Social life:
- She is a housewife.
- She has 2 children.
PHYSICAL EXAMINATION
General Moderately ill, GCS: 4-5-6
status BW: 50 kg Height: 155 cm
(BMI 20,83 normoweight)

Vital sign BP: 110/80 mmHg HR: 109 bpm

RR: 32 bpm Tax: 36,5°C

Head & Anemic conjunctiva -/-,

Neck Icteric sclera -/-,
JVP R + 2 cmH2O.

4
PHYSICAL EXAMINATION
Thorax Pulmo:
symetrical,
vesicular sound +/+
+/+
+/↓
Rh-/-, Wh -/-
Cardiac:
ictus at 5th ICS left MCL, single S1/ S2,
murmur (-), gallop (-)
Abdomen Distended, shifting dullness (+), BS↑

Extremities Warm acral, parese -/-, edema -/-

Genitalia Ext Fluxus (-), Fluor (-)
5
HEMATOLOGY 30/03/18 Reference

Hemoglobin 13,70 11,4 – 15,1 g/dl

Erythrocyte 4,73 4,0 – 5,0.106/µl
Hematocrit 38,30 38 – 42 %
MCV 81,00 80 – 93 fl
MCH 29,00 27 – 31 pg
MCHC 35,80 32 – 36 g/dL
RDW 15,30 11,5 – 14,5 %
Leukocyte 1,44 4,7 – 11,3 x 103/µl
Thrombocyte 14 142 – 424 x 103/µl
Diff. count 0/1/66/28/5 0-4/0-1/51-67/25-33/2-5
BLOOD 30/03/18 Reference
CHEMISTRY
AST/ SGOT 20 0 - 32 U/L
ALT/ SGPT 15 0 - 33 U/L
Albumin 2,13 3,5 - 5,5 g/dL

eGFR: 15,58
Ureum mL/min/1,73 m2 151,20 16.6 - 48.5 mg/dL
Creatinine 3,43 < 1.2 mg/dL
RBS 142 < 200 mg/dL
Serum 30/03/18 Reference
Electrolyte
Natrium 109 136 - 145 mmol/L
Kalium 4,26 3,5 - 5,0 mmol/L
Chloride 83 98 - 106 mmol/L

Immunoserology 30/03/18 Reference

CA-125 55,60 < 35 U/mL

BLOOD 30/03/18 Reference
CHEMISTRY
Blood Gas Analysis
pH 7,44 7,35-7,45
pCO2 21,0 35-45 mmHg
pO2 158,6 80-100 mmHg
HCO3 14,4 21-28 mmol/L
BE -10,0 (-3)-(+3) mmol/L
SaO2 99,4 > 95 %
Hb 13,8 g/dL
Temperature 37,0 ℃

 Mixed respiratory alkalosis and

metabolic acidosis
Hemostasis
PPT 30/03/18 Reference

Patient 11,00 second 9,4 – 11,3

Control 11,1 second -
INR 1,06 < 1,5
APTT
Patient 26,70 second 24,6 – 30,6
Control 26,9 second -
URINALYSIS 30/03/18 Reference

Clarity Clear -
Color Yellowish -
pH 5,5 4,5-8.0
SG 1,020 1,005-1.030
Glucosa negative negative
Protein +1 negative
Keton negative negative
Bilirubin negative negative
Urobilinogen +1 negative
Nitrit negative negative
Leukocyte negative negative
Blood +3 negative
URINALYSIS 30/03/18 Reference

10 x
Epithel 0,5 ≤3
Cylinder negative LPF
40 x
Erythrocyte 161,1 ≤3
Eumorphic 95 %
Dismorphic 5 %
Leukocyte 1,0 ≤5
Crystal - HPF
Bacteria 414,7 x 103/mL ≤ 93 x 103/mL
Others - -
Conclusion:
 Left ovarium: Clear Cell Adenocarcinoma,
with metastase to omentum, rectum, and
vesica urinaria.
 Uterus and Right Adnexa: no tumour cell.
 Free fluid within abdominal cavity
 Ren: stone/nodul/cyst (-)
 Conclusion:
 Ascites
 Bilateral hydronephrosis gr II

Conclusion:
 Pleural effusion sinistra.
 1. PCCL PL IDx PDx
Female, 42 y.o -Pleural -Pseudo − Ascites
effusion Meigs' fluid
Laboratory: sinistra Syndrome analysis
-Alb: 2,13 g/dL ↓ -Ascites d.t. Ovarian − Monitoring
-CA-125: 55,60 U/mL ↑ -Ovarian Cancer albumin
-BGA: Mixed cancer − Globulin,
respiratory alkalosis Total
and metabolic acidosis protein,
Chest X-Ray: pleural ALP, GGT
effusion sinistra − SPE
Abd USG: ascites − Bilirubin
PA: Clear Cell T/D/I
Adenocarcinoma, with
metastase to omentum,
rectum, and vesica
urinaria.
 1. PCCL PL IDx PDx

Physical Examination:
-Tachycardia, Tachypnea.
-Abd: distended, shifting
dullness (+).

Anamnesa:
-shortness of breath since
4 days ago.
-had been diagnosed
ovarian cancer 4 months
ago.
-had been operated 2
months ago, got
chemotherapy 5x
(carboplastin &
paclitaxel)
 2. PCCL PL IDx PDx
Female, 42 y.o - Sepsis -Sepsis -Bilirubin
Laboratory: d.t. T/D/I
-Thro:14x103/µl ↓ 1. GI -Procalcitonin
-Creatinine 3,43 ↑ infection -Blood culture
& sensitivity
-pO2 158,6 mmHg test
-Tachycardia -Fecal
-Tachypnea analysis
-Abd: BS↑ -Monitoring
Anamnesa: BGA and
-diarrhea since 5 SOFA score
days,freq. 7x/day
-vomiting 7x/ day
-BP: 110/80 mmHg
MAP: 90
-GCS 456
-SOFA score 9
 3. PCCL PL IDx PDx
Female, 42 y.o -Acute -Acute − Monitoring
Kidney Kidney serum
Laboratory: Injury Injury ureum,
- Ureum 151,2 mg/dL ↑ d.t. no 2 creatinine
- Creatinine 3,43 mg/dL ↑ − Monitoring
- e GFR: 15,58 ↓ urinalysis
mL/min/1,73m2 and urine
output
Abd USG: bilateral
hydronephrosis gr II

• Urinalysis:
-proteinuria +1
-blood +3
-ery 161/ HPF
-eumorphic 95%
 4. PCCL PL IDx PDx
Female, 42 y.o -Hyponatremia -Electrolyte −Monitoring
hypoosmolality imbalance serum
Laboratory: -Hypochloremia d.t. electrolyte
-Na: 109 mmol/L ↓ 1. Acute −FE Na
-K: 4,26 mmol/L Gastro- −Urine
-Cl: 83 mmol/L ↓ enteritis electrolyte
-Serum osmolality: −Fecal
259,64 mOsm/kg↓ analysis

-Tachycardia
-Tachypnea
-Abd: BS↑

Anamnesa:
-diarrhea since 5
days,freq. 7x/day
-vomiting 7x/ day
 5. PCCL PL IDx PDx
Female, 42 y.o -Bicytopenia -Bicytopenia −Monitoring
Laboratory: d.t. Chemo- CBC
-Hb: 13,7 g/dL  therapy
history transfusion induced
(PRC 2 packs,
TC 1 pack)
-Leuko: 1,44x103/µl ↓
-Thro: 14x103/µl ↓
-CA-125:55,60 U/mL ↑
Anamnesa:
-had been diagnosed
ovarian cancer
4 months ago.
-had been operated
2 months ago, got
chemotherapy 5x
(carboplastin & paclitaxel)
THANK YOU