Background: Meigs syndrome, pseudo-Meigs syndrome, and pseudo-pseudo-Meigs syndrome showcase a diagnostic challenge in the management of complex pediatric cases. Case report: We report a case of a 6-year-old girl who presented with progressive breathlessness, lethargy, and constipation for two weeks, associated with multiple episodes of joint pain and polymorphous rash. Imaging of the thorax, abdomen, and pelvis suggested bilateral pleural effusion, ascites, and an ovarian mass with abdominal involvement. The pleural and peritoneal fluids were exudative in nature. Unfortunately, she was not fit for a biopsy of the mass and was treated in the intensive care unit for one month. She was initiated on oral corticosteroids for suspicion of an underlying autoinflammatory disease. However, subsequent investigations yielded inconclusive results. She gradually recovered and was well for a year. She presented again with constitutional symptoms and was diagnosed with diffuse large B-cell lymphoma (DLBCL). Thus, it was retrospectively apparent that this was a case of pseudo-Meigs syndrome.

The clinical presentation symptoms among psychiatric pediatric patients often illustrate the characteristic psychotic features of traumatized children. Cases may go underdiagnosed, misdirected, or commonly treated inappropriately. Clinical studies have conclusively shown an obvious link between childhood trauma and the emergence of symptoms. Transient dissociative episodes are common and normative phenomena during childhood. We reported a case of an 8-year-old boy, who presented with a 5-day history of hallucinatory behavior. He was causing significant nuisances, sudden onset of shouting aggressively, and behavioral changes, associated with neuropsychiatric presentation such as repetitive irregular movement involving his head, neck, and upper limb. There was an asynchrony of symptoms exhibited which were unexplained by clinical semiology or patterns. He was screaming in fear, talking irrelevantly, and acting suspiciously. This was his first presentation to the hospital and no features to suggest organicity. There was no family history of mental illness. No substances, or alcohol and drug usage Serial investigation turned out to be normal and unremarkable. The episodes get frequent whenever parents or hospital staff give more attention toward him. He was given a low dose of antipsychotics, but no obvious rapid changes were observed afterward. Further exploration noted, his parents reported that the patient had been very worked up with past related trauma at school and constantly talking about it. He was afraid, distressed, and anxious as he felt something bad would happen to him. There were significant issues related to attachment figures in this boy, possibly the absent parenting style. He spent most of time playing online games and was preoccupied with them on a daily basis.