Cytomegalovirus-associated protein-losing gastropathy in childhood

REVIEW
Cytomegalovirus-associated protein-losing gastropathy
in childhood
O. Megged & Y. Schlesinger
Received: 20 May 2008 / Accepted: 25 June 2008
# Springer-Verlag 2008
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 proteinlosing
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 CMVassociated
protein-losing gastropathy, all in one mediumsized
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 . Children
Abbreviations
CMV Cytomegalovirus
PCR Polymerase chain reaction
TGF Transforming growth factor
HP Helicobacter pylori
Introduction
Menetrier’s disease is an uncommon disease in childhood,
which is characterized by gastric hypertrophy involving
predominantly the fundus and body, and hypoalbuminemia
secondary to protein loss through the gastric mucosa.
Children usually have self-limited disease, lasting for a
few weeks, mostly requiring only supportive care. One of
the major causes of Menetrier’s disease in children is
cytomegalovirus (CMV) infection.
In this paper, we describe eight children with Menetrier’s
disease associated with CMV infection over a five-year
period and review the literature about this entity.
Methods
The medical records of eight children diagnosed with
CMV-associated protein-losing gastropathy were reviewed.
All patients were evaluated by a dietician to ensure that
protein intake was normal for age, and urine samples of all
patients revealed no proteinuria. Clinical and laboratory
features of the patients are presented in Table 1.
Eur J Pediatr
DOI 10.1007/s00431-008-0791-1
O. Megged : Y. Schlesinger
Department of Pediatrics and Infectious Diseases Unit,
Shaare Zedek Medical Center,
Hadassah-Hebrew University Medical School,
Jerusalem, Israel
O. Megged (*)
Infectious Diseases Unit, Shaare Zedek Medical Center,
P.O. Box 3235, Jerusalem 91031, Israel
e-mail: orlimegged@yahoo.com