A Unique Mechanism of Acute Ischemic Stroke in a Patient Presenting with Pseudo-Pseudo Meigs’ Syndrome Secondary to Systemic Lupus Erythematous (4573)

Objective: To advance knowledge about a unique mechanism of stroke in patients with systemic lupus erythematous (SLE). Background: SLE is a known risk factor for ischemic and hemorrhagic strokes. Several mechanisms are proposed for the pathophysiology of lupus-related ischemic strokes, including accelerated atherosclerosis, immune complex-mediated endothelial injury and vasculopathy, and thrombogenicity related to presence of antiphospholipid antibodies. We present a patient with a rare protein-losing enteropathy (PLE) and pseudo-pseudo Meigs’ syndrome (PPMS) with an elevated CA-125 level, ascites, pericardial and pleural effusions secondary to SLE. The severe protein loss results in a coagulopathic protein deficiency and subsequent ischemic stroke. Design/Methods: 62-year-old lady with relevant past medical history of breast cancer status post lumpectomy, radiation, and chemotherapy on anastrozole for chronic suppression and SLE, presented with worsening confusion and aphasia. She was found having an acute left middle cerebral artery ischemic stroke with a large amount of territory at risk, in the setting of a left common carotid artery thrombus. She underwent an endovascular thrombectomy. Extensive stroke workup ensued which revealed a CSF protein of 830.3 and evidence of an acute lupus flare. After ruling out other stroke etiologies and hypercoagulable states, the likely etiology was determined to be secondary to her rare condition of PLE and PPMS with resultant coagulopathic protein deficiency. Over the course of 11 days, patient’s condition improved. Secondary stroke prevention was maintained by treating the underlying SLE. Results: N/A Conclusions: Here we present a case of clinical Meigs’ syndrome without having an underlying pelvic malignancy and PLE secondary to lupus. There have only been few case reports in literature with association of SLE and PPMS. Equally uncommon is presentation of an adult with PLE secondary to lupus. To the best knowledge of the authors, this is the first case report of a unique mechanism of ischemic stroke in patients with lupus. Disclosure: Dr. Patel has nothing to disclose. Dr. Shepherd has nothing to disclose.