Cytomegalovirus-associated protein-losing gastropathy in childhood.
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.
Megged
O
O
Department of Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel. orlimegged@yahoo.com
Schlesinger
Y
Y
D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005758:Gastritis, Hypertrophic / Q000378:metabolism / Q000503:physiopathology* / Q000821:virology*; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D034141:Hypoalbuminemia / Q000175:diagnosis / Q000209:etiology*; D007075:Immunoglobulin M / Q000276:immunology; D007223:Infant; D008297:Male; D011504:Protein-Losing Enteropathies / Q000209:etiology*; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D007075:Immunoglobulin M; D014409:Tumor Necrosis Factor-alpha