Abstract
Ménétrier disease (MD) is characterized by enlarged gastric folds with associated protein losing gastropathy. In children it is a rare and self-limited cause of protein losing gastropathy. We report a case of a 2-year-old male who presented with prolonged, refractory emesis and peripheral edema. Workup revealed severe hypoalbuminemia, hypoproteinemia, iron deficiency anemia, and high stool alpha-1 antitrypsin. Hepatic protein synthesis was normal with no urinary protein loss. Endoscopy showed antrum sparing, severe erosive gastritis in body and fundus, characteristic of MD. Histologic examination displayed inflammation with eosinophilia, foveolar hyperplasia, atrophic oxyntic epithelium, and rare CMV inclusions. Patient received antiviral therapy, intravenous albumin, diuretic and was discharged on high protein diet. Follow-up revealed clinical recovery, with endoscopy and histology showing normal gastric mucosa throughout the stomach. It is important to remain vigilant of this condition in pediatric population and to include it in the differential diagnosis in cases of protein losing gastroenteropathy.
Highlights
Ménétrier disease (MD) is a rare disease typically found in adults, beginning insidiously with epigastric pain, nausea, vomiting, and generalized edema, it gradually becomes increasingly symptomatic with marked protein losing gastropathy [1] MD is considered a premalignant condition in adults being associated with gastric adenocarcinoma, often requiring gastrectomy. [2] In children, MD is rare, presents with identical symptomatology as in adults, but has a starkly different clinical course, as it is a benign, self-limited condition, with mean duration of 5 weeks. [3]We present a case of a child with protein losing gastropathy associated with chance finding of cytomegalovirus (CMV) inclusions in the gastric body mucosa
Histological findings of foveolar hyperplasia, oxyntic epithelial atrophy, and CMV inclusions in conjunction with endoscopy findings of gastritis with hypertrophic gastric folds, and clinical findings of peripheral edema, hypoproteinemia, hypoalbuminemia, elevated levels of stool alpha-1 antitrypsin, and positive CMV serology were all consistent with the diagnosis of Ménétrier disease
Pediatric MD is an uncommon, acute, self-limited hyperplastic gastropathy characterized by foveolar hyperplasia and oxyntic epithelial atrophy resulting in protein losing gastropathy [5]
Summary
Ménétrier Disease; 2-Year-Old Boy Presenting With Prolonged Emesis, Generalized Edema and Chance Histopathological Finding of Cytomegalovirus Gastritis: A Case Report. Received date: February 18, 2021; Accepted date: April 02, 2021; Published date: April 12, 2021 Citation: Narry Savage, Emmanuel Siaw, Ashish Patel, Shipra Garg (2021) Ménétrier Disease; 2-Year-Old Boy Presenting With Prolonged Emesis, Generalized Edema and Chance Histopathological Finding of Cytomegalovirus Gastritis: A Case Report. J. Archives of Medical Case Reports and Case Study. Archives of Medical Case Reports and Case Study. 4(2); DOI:10.31579/2692-9392/029
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