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Menetrier disease and Cytomegalovirus infection in paediatric age: report of three cases and a review of the literature

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Abstract

Paediatric Menetrier disease (PMD) is a protein-losing gastropathy, presenting with generalized oedema and abdominal symptoms. PMD commonly has an acute course and may be associated with Cytomegalovirus (CMV) infection. The aim of this retrospective study is to assess the epidemiological and clinical data, diagnostic procedures, treatment and outcome of CMV-associated PMD. The medical charts of the patients with PMD and CMV infection diagnosed at our hospital have been reviewed. Then, a systematic literature’s review of all the cases of PMD and a selection of those associated with CMV infection have been performed. Three previously healthy boys were admitted for vomiting and oedema. Endoscopy showed hypertrophic gastric folds and CMV infection was diagnosed. Albumin was administered in all cases, with clinical resolution within few weeks. In literature, PMD has been described in 150 children and the association between CMV and PMD was found in 89 cases. Clinical and laboratory data, radiological and histological exams, therapy and outcome were reviewed.

Conclusions: Basing on the present experience and on the current knowledge, PMD has a benign course without long-term sequelae. Although PMD is rare in children, we recommend paediatricians to consider CMV-related PMD when facing children with vomiting and diffuse oedema.

What is Known:

• Paediatricians should consider Menetrier disease (MD) when facing oedematous child complaining of abdominal symptoms with hypoalbuminemia, without proteinuria and liver dysfunction.

• Typical ultrasound features (hypertrophic gastric folds) suggest such condition which requires endoscopy and biopsy for definitive diagnosis.

What is New:

• A familial susceptibility to CMV gastric infection has been recently suggested; thus when suspecting MD, the family history of gastric diseases should be investigated.

• Menetrier disease has been found associated with other unusual conditions either benign (such as gastric bezoar) or malign as neoplasms (acute lymphatic leukaemia and adenocarcinoma) even in children.

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Abbreviations

CMV:

Cytomegalovirus

CRP:

C-reactive protein

CT:

Computerized tomography

ED:

Emergency Department

EGDS:

Esophagogastroduodenoscopy

HP :

Helicobacter pylori

IB:

Inclusion bodies

MD:

Menetrier disease

PCR:

Polymerase chain reaction

PLG :

Protein-losing gastropathy

PMD:

Paediatric Menetrier disease

PPIs:

Proton pump inhibitors

TGF-α:

Transforming growth factor alpha

US:

Ultrasound

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Authors and Affiliations

  1. Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital, Viale Pieraccini 24, 50139, Florence, Italy

    Federica Barbati & Edoardo Marrani

  2. NEUROFARBA Department, University of Florence, Meyer Children’s Hospital, Florence, Italy

    Giuseppe Indolfi

  3. Gastroenterology Unit, NEUROFARBA Department, University of Florence, Meyer Children’s Hospital, Florence, Italy

    Paolo Lionetti

  4. Pediatric Unit, Department of Sciences of Health, University of Florence, Meyer Children’s Hospital, Florence, Italy

    Sandra Trapani

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  1. Federica Barbati
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  2. Edoardo Marrani
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  3. Giuseppe Indolfi
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  4. Paolo Lionetti
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  5. Sandra Trapani
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Contributions

Dr. Federica Barbati and Dr. Edoardo Marrani participated in literature search, article selection, data collection and writing original draft preparation. Prof Giuseppe Indolfi and Prof Paolo Lionetti contributed to the conceptualization, writing review and editing. Dr. Sandra Trapani supervised the design and execution of the study and participated in conceptualization, methodology, writing review and editing.

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Correspondence to Federica Barbati.

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Barbati, F., Marrani, E., Indolfi, G. et al. Menetrier disease and Cytomegalovirus infection in paediatric age: report of three cases and a review of the literature. Eur J Pediatr 180, 679–688 (2021). https://doi.org/10.1007/s00431-020-03782-6

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