Cytomegalovirus-associated protein-losing gastropathy in childhood
- 516 Downloads
- 28 Citations
Abstract
Menetrier’s disease is an uncommon disease in childhood, characterized by gastric hypertrophy and hypoalbuminemia secondary to protein loss through the gastric mucosa. This paper describes a series report of protein-losing gastropathy associated with cytomegalovirus (CMV) infection in children and reviews the literature. We reviewed the medical records of eight children with diagnosis of Menetrier’s disease or protein-losing gastropathy with evidence of acute CMV infection. During a five-year period there were eight children that were diagnosed with CMV-associated protein-losing gastropathy, all in one medium-sized pediatric ward in a general hospital. The mean age was 32 months and there was no gender predominance. The most common presenting symptoms were vomiting and edema. Average symptoms’ duration prior to admission was 3.2 weeks and mean albumin at presentation was 1.8 g/dl (range, 1.5–2.5 g/dl; normal values, 3.5–5 g/dl). All eight children fully recovered. In conclusion, CMV infection should be suspected in every child who presents with protein-losing gastropathy. The availability of newer, rapid diagnostic techniques such as polymerase chain reaction (PCR) may facilitate diagnosis, as serology studies may be misleading. Usually, only supportive care is required, but treatment with ganciclovir may be considered for severe or prolonged cases.
Keywords
Cytomegalovirus Protein losing gastropathy Menetrier’s disease ChildrenAbbreviations
- CMV
Cytomegalovirus
- PCR
Polymerase chain reaction
- TGF
Transforming growth factor
- HP
Helicobacter pylori
References
- 1.Black JO, White J, Abramowsky C, Shehata B (2004) Pathologic quiz case. Edema and diarrhea in a 2-year-old boy. Menetrier disease with cytomegalovirus gastritis. Arch Pathol Lab Med 128:117–119Google Scholar
- 2.Chang KW, Lin SJ, Hsueh C, Kong MS (2004) Menetrier’s disease associated with cytomegalovirus infection in a child. Acta Paediatr Taiwan 41:339–340Google Scholar
- 3.Cheong JL, Cowan FM, Modi N (2004) Gastrointestinal manifestations of postnatal cytomegalovirus infection in infants admitted to a neonatal intensive care unit over a five year period. Arch Dis Child Fetal Neonatal Ed 89:367–369CrossRefGoogle Scholar
- 4.Cieslak TJ, Mullett CT, Puntel RA, Latimer JS (1993) Menetrier’s disease associated with cytomegalovirus infection in children: report of two cases and review of the literature. Pediatr Infect Dis J 12:340–343PubMedGoogle Scholar
- 5.Coad NA, Shah KJ (1986) Menetrier’s disease in childhood associated with cytomegalovirus infection: a case report and review of the literature. Br J Radiol 59:615–620PubMedCrossRefGoogle Scholar
- 6.Drut RM, Gomez MA, Lojo MM, Drut R (1995) Cytomegalovirus-associated Menetrier’s disease in adults. Demonstration by polymerase chain reaction (PCR). Medicina (B Aires) 55:659–664Google Scholar
- 7.Eisenstat DD, Griffiths AM, Cutz E, Petric M, Drumm B (1995) Acute cytomegalovirus infection in a child with Menetrier’s disease. Gastroenterology 109:592–595PubMedCrossRefGoogle Scholar
- 8.Faure C, Besnard M, Hirsch A, Mougenot JF, Peuchmaur M, Cezard JP, Navarro J (1996) Chronic hypertrophic gastropathy in a child resembling adult Menetrier’s disease. J Pediatr Gastroenterol Nutr 23:419–421PubMedCrossRefGoogle Scholar
- 9.Graham-Maar RC, Russo P, Johnson AM (2006) A 2-year-old boy with emesis and facial edema. MedGenMed 8:75PubMedGoogle Scholar
- 10.Henderson SE, Sprague PL (1979) A case of hypertrophic protein losing gastropathy. Pediatr Radiol 8:261–262PubMedCrossRefGoogle Scholar
- 11.Hochman JA, Witte DP, Cohen MB (1996) Diagnosis of cytomegalovirus infection in pediatric Menetrier’s disease by in situ hybridization. J Clin Microbiol 34:2588PubMedGoogle Scholar
- 12.Hoffer V, Finkelstein Y, Balter J, Feinmesser M, Garty BZ (2003) Ganciclovir treatment in Menetrier’s disease. Acta Paediatr 92:983–985PubMedCrossRefGoogle Scholar
- 13.Iwanaga M, Zaitsu M, Ishii E, Nishimura Y, Inada S, Yoshiki H, Okinami S, Hamasaki Y (2004) Protein-losing gastrogastropathy and retinitis associated with cytomegalovirus infection in an immunocompetent infant: a case report. Eur J Pediatr 163:81–84PubMedCrossRefGoogle Scholar
- 14.Khoshoo V, Alonzo E, Correa H, Levine S, Udall JN Jr (1994) Pathological case of the month. Menetrier’s disease with cytomegalovirus gastritis. Arch Pediatr Adolesc Med 148:611–612PubMedGoogle Scholar
- 15.Kovacs AA, Churchill MA, Wood D, Mascola L, Zaia JA (1993) Molecular and epidemiologic evaluations of a cluster of cases of Menetrier’s disease associated with cytomegalovirus. Pediatr Infect Dis J 12:1011–1014PubMedCrossRefGoogle Scholar
- 16.Leonidas JC, Beatty EC, Wenner HA (1973) Menetrier disease and cytomegalovirus infection in childhood. Am J Dis Child 126:806–808PubMedGoogle Scholar
- 17.Marks MP, Lanza MV, Kahlstrom EJ, Mikity V, Marks SC, Kvalstad RP (1986) Pediatric hypertrophic gastropathy. AJR Am J Roentgenol 147:1031–1034PubMedGoogle Scholar
- 18.Nakase H, Itani T, Mimura J et al (1998) Transient protein-losing gastropathy associated with cytomegalovirus infection in a non-compromised host: a case report. Am J Gastroenterol 93:1005–1006PubMedCrossRefGoogle Scholar
- 19.Numazaki K, Ikehata M, Chiba S (1997) Role of cytomegalovirus in Menetrier disease in children. J Pediatr 130:681–682PubMedGoogle Scholar
- 20.Occena RO, Taylor SF, Robinson CC, Sokol RJ (1993) Association of cytomegalovirus with Menetrier’s disease in childhood: report of two new cases with a review of literature. J Pediatr Gastroenterol Nutr 17:217–224PubMedGoogle Scholar
- 21.Oderda G, Cinti S, Cangiotti AM, Forni M, Ansaldi N (1990) Increased tight junction width in two children with Menetrier’s disease. J Pediatr Gastroenterol Nutr 11:123–127PubMedGoogle Scholar
- 22.Pinho Vaz C, Ibrahim A, Avila Garavito A et al (1996) Protein-losing gastropathy associated with cytomegalovirus: a rare and late complication of allogeneic bone marrow transplantation. Bone Marrow Transplant 17:887–889PubMedGoogle Scholar
- 23.Sferra TJ, Pawel BR, Qualman SJ, Li BU (1996) Menetrier disease of childhood: role of cytomegalovirus and transforming growth factor alpha. J Pediatr 128:213–219PubMedCrossRefGoogle Scholar
- 24.Suter WR, Neuweiler J, Borovicka J, Binek J, Fantin AC, Meyenberger C (2000) Cytomegalovirus-induced transient protein-losing hypertrophic gastropathy in an immunocompetent adult. Digestion 62:276–279PubMedCrossRefGoogle Scholar
- 25.Stillman AE, Sieber O, Manthei U, Pinnas J (1981) Transient protein-losing gastropathy and enlarged gastric rugae in childhood. Am J Dis Child 135:29–33PubMedGoogle Scholar
- 26.Tokuhara D, Okano Y, Asou K, Tamamori A, Yamano T (2007) Cytomegalovirus and Helicobacter pylori co-infection in a child with Menetrier disease. Eur J Pediatr 166:63–65PubMedCrossRefGoogle Scholar
- 27.Xiao SY, Hart J (2001) Marked gastric foveolar hyperplasia associated with active cytomegalovirus infection. Am J Gastroenterol 96:223–226PubMedCrossRefGoogle Scholar
- 28.Yoshioka M, Ishiguro N, Ma X, Kikuta H, Kodaira J, Itoh T, Kobayashi K (2002) Protein-losing cytomegalovirus gastritis in a patient with Stevens-Johnson syndrome. Digestion 65:234–237PubMedCrossRefGoogle Scholar