Co-Infection with Cytomegalovirus and Helicobacter pylori in a Child with Ménétrier's Disease

Abstract

Ménétrier's disease is a rare protein-losing gastropathy characterized by hypertrophic gastric fold, foveolar hyperplasia, and hypoproteinemia with resulting peripheral edema. It is clinically evident as nonspecific gastrointestinal symptoms, including abdominal discomfort, nausea and vomiting, abdominal pain, weight loss, diarrhea, and edema. Pediatric Ménétrier's disease usually has an insidious onset and progressive, chronic clinical course and it spontaneously resolves in weeks or months. The pathogenesis of Ménétrier's disease is not clearly understood. Ménétrier's disease is thought to be associated with some gastric infections. But the cause of Ménétrier's disease is unknown, an association with cytomegalovirus (CMV) and Helicobacter pylori has been suggested. In Korea, We present the first a case of pediatric Ménétrier's disease with positive evidence of CMV and H. pylori.

Keywords: Cytomegalovirus; Helicobacter pylori; Ménétrier's disease.

Fig. 1

Endoscopic findings of the present case. (A) Initial esophagogastroduodenoscopy shows enlarged erythematous gastric folds, and exudation in entire stomach. (B) Seven weeks after discharge, endoscopic findings were nearly normalized.

Fig. 2

A gastric biopsy shows the proliferation of the gastric glands (surrounded by arrows) and cystic dilatation without increase of granulocytes or eosinophils (immunostain, ×400).

Fig. 3

Cytomegalovirus (CMV) intranuclear inclusions (block dots indicated by arrows) were detected from gastric tissue using in-situ hybridization (H&E stain, ×400).