Background and Aims: Pediatric Menetrier's disease (PMD) is a rare, protein-losing gastroenteropathy characterized by hypertrophic gastric folds, manifesting with vomiting and generalized edema. PMD commonly has an acute, self-limited course and may be associated with Cytomegalovirus (CMV) infection.
Method: The medical records of 3 patients with PMD and acute CMV infection diagnosed at Anna Meyer Children's Hospital have been reviewed.
Results: 3 previously healthy boys, aged between 2-months and 3-years, presented with protracted vomiting, periorbital and generalized edema. The toddler showed also bloody diarrhea, dehydration and important weight loss. In all cases, laboratory studies revealed severe hypoproteinemia and hypoalbuminemia, with no evidence of proteinuria or liver dysfunction. Coeliac disease was excluded. CMV IgM and IgG antibody tests were positive, with low IgG avidity. In 2 cases, CMV DNA by PCR was detected in blood and urine samples. Gastrointestinal endoscopy showed erythematosus gastric mucosa, hypertrophic gastric folds in the body and fundus in 2 cases, lymphatic hyperplasia and aphthous ulcers in one. Histopathological examination revealed foveolar hyperplasia, dilated gastric glands; in 2 cases CMV inclusion bodies were found. Intravenous albumin transfusions and diuretics were administered in all patients, antivirals in 2 cases, with clinical resolution within few weeks
Conclusions: Vomiting, hypoproteinemia with generalized edema, without renal and liver dysfunction, lead to protein-losing gastroenteropathy, such as Menetrier's disease. This condition is very rare in children with a benign and self-limiting course, often associated with CMV infection. Therefore, we recommend pediatricians to detect CMV infection and to perform gastroscopic examination with biopsy, facing children with vomiting and diffuse edema

CMV INFECTION AS TRIGGER OF MENETRIER’S DISEASE: THREE CASES IN INFANCY