Cytomegalovirus-Associated Protein-Losing Gastropathy (Menetrier’s Disease) in Childhood

Abstract

Pediatric Menetrier disease is a rare clinical event with unknown etiology, which has a different course from that in adults. It is characterized by gastric hypertrophy and hypoalbuminemia secondary to protein loss throughout the gastric mucosa. Menetrier disease is usually self-limiting in children. In particular, in patients with immune deficiency, one of the most important cause for Menetrier disease is cytomegalovirus (CMV) infection. This infection can also be observed in immunocompetent children. A girl aged two and a half years with a one-week history of generalized edema, weakness, and decreased urine output was admitted at the Pediatric Department of Şişli Hamidiye Etfal Training and Research Hospital. Periorbital and pretibial edema, abdominal distension, and ascites were detected and laboratory studies revealed hypoalbuminemia and elevated fecal alpha-1 antitrypsin excretion. According to the serological investigations, anti-CMV IgM antibodies were detected positive and CMV DNA values were found to be 1170 copies/mL. The patient was treated with intravenous albumin infusion, PPI therapy, and a high-protein and low-salt diet. On the 10 th day of treatment, her condition gradually improved without any antiviral drug. We prepared this presentation because we determined CMV as an etiological agent of protein-losing gastropathy in a child with a healthy immune system. (JAREM 2016; 6: 56-8)