BACKGROUND: Pseudo-pseudo Meigs syndrome (PPMS), or Tjalma syndrome, is a rare systemic lupus erythematosus (SLE)-associated phenotype characterized by ascites, pleural effusion, and elevated CA125 without an ovarian neoplasm. After assisted reproductive technology (ART), it may overlap with ovarian hyperstimulation syndrome (OHSS) or mimic gynecologic malignancy. CASE PRESENTATION: A 25-year-old woman underwent two controlled ovarian stimulation (COS) cycles for intracytoplasmic sperm injection (ICSI) because of severe male-factor infertility. Before ART, she had autoimmune thyroid disease and transient urinary abnormalities, but no known SLE. During the second COS cycle, hypertension and albuminuria emerged. Following oocyte retrieval, she developed massive ascites, bilateral pleural effusions, adnexal abnormalities, and marked CA125 elevation, initially raising suspicion of OHSS and ovarian malignancy. Subsequent nephrotic-range proteinuria, profound hypoalbuminemia, hypocomplementemia, and SLE-associated autoantibodies supported active SLE with substantial renal involvement. Cytologic and microbiologic investigations provided no evidence of malignancy or infection. Following SLE-directed treatment, renal abnormalities and serosal effusions improved. At eight months, the adnexal abnormalities had completely resolved and CA125 had normalized, supporting a PPMS phenotype. CONCLUSION: Atypical or persistent post-ART effusions, particularly when accompanied by evolving renal or immunologic abnormalities, should prompt consideration of SLE-associated PPMS as an important differential diagnosis beyond OHSS and gynecologic malignancy. Longitudinal evaluation and multidisciplinary assessment may facilitate timely recognition of this rare phenotype and guide appropriate clinical management.