A Case of Pediatric Menetrier's Disease Associated with Helicobacter pylori Infection

ABSTRACT

Menetrier's disease in childhood is a rare form of gastropathy characterized by hypoalbuminemia, endoscopic and/or radiologic findings of hypertrophic gastric folds, and histologic findings of foveolar hyperplasia in the stomach. It tends to have a self-limited course compared to the chronic and complicated course in adult Menetrier's disease. A 7-year-old boy was referred to Incheon St. Mary's Hospital for facial edema. Physical examination on admission showed periorbital swelling, pitting edema in both legs, and epigastric tenderness. Laboratory tests on admission indicated hypoproteinemia (3.0 g/dL) with hypoalbuminemia (2.1 g/dL) and hypogammaglobulinemia. Urinalysis showed no abnormalities. The test results for anti-cytomegalovirus immunoglobulin M and cytomegalovirus PCR were negative. Stool Helicobacter pylori antigen was positive and fecal alpha1-antitrypsin clearance was 40.1 mL/day, consistent with protein-losing gastroenteropathy. Gastroduodenoscopy showed hypertrophic edematous gastric folds, erythema, and superficial erosion in the body of the stomach. The duodenum was normal. Histologic findings showed foveolar hyperplasia. His symptoms improved with conservative treatment including proton pump inhibitor from day 9 of hospitalization and resolved completely. Here we reported a case of pediatric protein-losing hypertrophic gastropathy associated with Helicobacter pylori infection.