Clin Endosc.  2018 Jan;51(1):89-94. 10.5946/ce.2017.038.

Ménétrier’s Disease as a Gastrointestinal Manifestation of Active Cytomegalovirus Infection in a 22-Month-Old Boy: A Case Report with a Review of the Literature of Korean Pediatric Cases

• Hong J
• Lee S
• Shon Y

• KMID: 2403638
• DOI: http://doi.org/10.5946/ce.2017.038

Abstract

Ménétrier's disease (MD), which is characterized by hypertrophic gastric folds and foveolar cell hyperplasia, is the most common gastrointestinal (GI) cause of protein-losing enteropathy (PLE). The clinical course of MD in childhood differs from that in adults and has often been reported to be associated with cytomegalovirus (CMV) infection. We present a case of a previously healthy 22-month-old boy presenting with PLE, who was initially suspected to have an eosinophilic GI disorder. However, he was eventually confirmed, by detection of CMV DNA using polymerase chain reaction (PCR) with gastric tissue, to have MD associated with an active CMV infection. We suggest that endoscopic and pathological evaluation is necessary for the differential diagnosis of MD. In addition, CMV DNA detection using PCR analysis of biopsy tissue is recommended to confirm the etiologic agent of MD regardless of the patient's age or immune status.

Keyword

Cytomegalovirus; Protein-losing enteropathies; Gastritis, hypertrophic; Ménétrier’s disease; Child

MeSH Terms

Adult
Biopsy
Child
Cytomegalovirus Infections*
Cytomegalovirus*
Diagnosis, Differential
DNA
Eosinophils
Gastritis, Hypertrophic
Humans
Hyperplasia
Infant*
Male*
Polymerase Chain Reaction
Protein-Losing Enteropathies
DNA

Figure

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  Fig. 1. Abdominal ultrasonographic finding showing thickened gastric mucosa with prominent rugae (arrows).

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  Fig. 2. Esophagogastroduodenoscopy findings. (A) A markedly edematous mucosa and hemorrhagic erosions covered with whitish mucus throughout the gastric body. (B) The hypertrophic gastric folds noted in the fundus and body. (C, D) Numerous polypoid masses with superficial ulcers diffusely distributed in the antrum.

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  Fig. 3. Upper gastrointestinal series finding. Prominent enlarged and polypoid gastric folds of the body and antrum (arrows) with regular mucosal folds of the jejunum.

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  Fig. 4. Histological examinations of gastric biopsy specimens. (A) Hyperplastic foveolar cells with a corkscrew appearance (hematoxylin and eosin stain, ×100). (B) Scattered eosinophil (arrow) in the laminar propria where lymphocyte infiltration is not prominent (H&E stain, ×200). (C) A few glands showing cystic dilatational changes (H&E stain, ×200).

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  Fig. 5. Repeated gastroscopic findings performed in 4 weeks after discharge showing a healed mucosa with resolution of the erosive and polypoid lesion.

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