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Ciavaldini A, Delattre C, Bousquet A, Mestiri R, Nguyen AT, Vanquaethem H, Conan PL, Caré W. [Severe cytomegalovirus-associated protein losing gastropathy in an immunocompetent adult]. Rev Med Interne 2023; 44:195-198. [PMID: 36639308 DOI: 10.1016/j.revmed.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Clinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage. OBSERVATION We report the case of a 28-year-old man, considered immunocompetent and without medical history, presenting with a primary CMV infection revealed by a severe protein-losing gastroenteropathy (serum albumin level: 18.9g/L). The CT scan showed a gastro-duodeno-jejuno-ileitis pattern. Upper intestinal endoscopy revealed diffuse ulcerated and congestive gastritis predominantly in the fundus. Histological analysis of the biopsies showed no viral inclusion and no immunohistochemical staining reaction, but a high viral load (5.61 log). Treatment was symptomatic associated with anticoagulation due to the major hypoalbuminemia. The patient slowly recovered, and normal clinical examination and blood tests were observed two months after the onset of symptoms. CONCLUSION Severe CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.
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Affiliation(s)
- A Ciavaldini
- Service de médecine interne, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Delattre
- Service d'hépato-gastro-entérologie, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - A Bousquet
- Service de biologie médicale, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - R Mestiri
- Service de médecine interne, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - A-T Nguyen
- Service de pathologie, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - H Vanquaethem
- Service de médecine interne, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - P-L Conan
- Service de maladies infectieuses et tropicales, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - W Caré
- Service de médecine interne, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Hirsch BS, Cardoso SR, Baba ER, de Moura DTH, Gonçalves MEP, Rocha RSDP, de Moura EGH. Chronic Ménétrier disease leading to gastric cancer in youth. Clin Endosc 2023; 56:125-128. [PMID: 36733991 PMCID: PMC9902682 DOI: 10.5946/ce.2022.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil,Correspondence: Bruno Salomão Hirsch Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr Eneas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, Sao Paulo 05403-010, Brazil E-mail:
| | - Silvia R. Cardoso
- Instituto da Crianca, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Elisa R. Baba
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Diogo T. H. de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Manoel Ernesto P. Gonçalves
- Instituto da Crianca, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo S. de P. Rocha
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo G. H. de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Munden MM, Paltiel HJ. The Gastrointestinal Tract. PEDIATRIC ULTRASOUND 2021:283-353. [DOI: 10.1007/978-3-030-56802-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Panarelli NC. Infectious diseases of the upper gastrointestinal tract. Histopathology 2020; 78:70-87. [PMID: 33382485 DOI: 10.1111/his.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person-to-person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.
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Development of a Predictive Model Using Endoscopic Features for Gastric Cytomegalovirus Infection in Renal Transplant Patients. Transplantation 2018; 103:998-1004. [PMID: 30507742 DOI: 10.1097/tp.0000000000002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a common viral pathogen in transplant patients which often targets the stomach. However, the endoscopic characteristics of gastric CMV infection are not well established. We aimed to develop a predictive model using endoscopic findings for gastric CMV infection in renal transplant patients. METHODS A retrospective study of 287 kidney transplant recipients who underwent endoscopy with biopsy for suspected CMV infection from January 2006 to November 2015 at a tertiary referral hospital was performed. CMV infection was defined based on inclusion bodies in hematoxylin and eosin and immunohistochemical staining. Endoscopic and clinical parameters related to gastric CMV infection were selected by univariate analyses. Multivariate logistic regression was used to create a predictive model from β-coefficients. RESULTS CMV was present in 107 (37.7%) of the 287 patients. Multivariate analysis found age (odds ratio [OR], 0.964; 95% confidence interval [CI], 0.938-0.99; P = 0.008), erosions with surface exudate (OR, 5.34; 95% CI, 2.687-10.612; P < 0.001), raised shape of erosions (OR, 3.957; 95% CI, 1.937-8.083; P < 0.001), and antral location of ulcers (OR, 15.018; 95% CI, 5.728-39.371; P < 0.001) as independent predictive factors for gastric CMV infection. Using the predictive model created from this analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71.03%, 85.56%, 74.51%, 83.24%, and 80.14%, respectively. The area under the receiver operating characteristic curve of this model for detecting CMV infection was 0.850 (95% CI, 0.803-0.889; P < 0.001). CONCLUSIONS The predictive model with typical endoscopic findings may be useful for detecting gastric CMV infection in renal transplant patients.
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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Hutto EH, Anderson DC, Mansfield KG. Cytomegalovirus-associated Discrete Gastrointestinal Masses in Macaques Infected with the Simian Immunodeficiency Virus. Vet Pathol 2016; 41:691-5. [PMID: 15557079 DOI: 10.1354/vp.41-6-691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cytomegalovirus (CMV)-associated gastrointestinal masses have been reported in human acquired immune deficiency syndrome patients. This is the first report on CMV-associated gastrointestinal masses in simian immunodeficiency virus (SIV)-infected macaques. Two SIV-infected macaques presented at necropsy with multiple nodular or umbilicated masses within the gastrointestinal tract. In one animal, the masses were located throughout the gastrointestinal tract, whereas in the other, the masses were restricted to the proximal small intestine. Grossly, the masses were indistinguishable from those caused by neoplastic conditions such as lymphoma and, histologically, were composed of hyperplastic glandular tissue, dense neutrophilic infiltrates within the lamina propria, and multifocal proprial hemorrhage. Frequent cytomegalic cells with basophilic intranuclear inclusions were found in affected regions. Immunohistochemistry for CMV demonstrated frequent immunopositive cells within affected areas. Furthermore, immunohistochemistry for the proliferation marker Ki-67 demonstrated increased proliferation in hyperplastic glands and crypts. CMV should be considered a cause of discrete mass lesions in the gastrointestinal tract of SIV-infected macaques.
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Affiliation(s)
- E Hendricks Hutto
- New England Primate Research Center, One Pine Hill Drive, Southborough, MA 01772, USA.
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Yao X, Hao Liang W. Cytomegalovirus and Helicobacter Pylori Co-infection in an Adult with Ménétrier's Disease: A Case Report. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2016; 31:129-133. [PMID: 28031103 DOI: 10.1016/s1001-9294(16)30038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Xiang Yao
- Department of Gastroenterology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wang Hao Liang
- Department of Gastroenterology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Huh WJ, Coffey RJ, Washington MK. Ménétrier's Disease: Its Mimickers and Pathogenesis. J Pathol Transl Med 2015; 50:10-6. [PMID: 26689786 PMCID: PMC4734964 DOI: 10.4132/jptm.2015.09.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
Ménétrier’s disease is a rare protein-losing hypertrophic gastropathy. Histologically, it can be mistaken for other disorders showing hypertrophic gastropathy. The pathogenesis of Ménétrier’s disease is not fully understood; however, it appears that the epidermal growth factor receptor (EGFR) ligand, transforming growth factor alpha, contributes to the pathogenesis of this disorder. In this review, we will discuss disease entities that can mimic Ménétrier’s disease and the role of EGFR signaling in Ménétrier’s disease.
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Affiliation(s)
- Won Jae Huh
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Coffey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA ; Department of Veterans Affairs Medical Center, Nashville, TN, USA
| | - Mary Kay Washington
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Reggiani Bonetti L, Barresi V, Bertani A, Maccio L, Palmiere C. Human cytomegalovirus induced pseudotumor of upper gastrointestinal tract mucosa: Effects of long-term chronic disease? J Med Virol 2015; 87:1041-5. [DOI: 10.1002/jmv.24152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Angela Bertani
- Department of Gastroenterology; University of Modena; Italy
| | - Livia Maccio
- Division of Pathology; University of Modena; Italy
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Jones RP. Roles for Cytomegalovirus in Infection, Inflammation, and Autoimmunity. INFECTION AND AUTOIMMUNITY 2015:319-357. [DOI: 10.1016/b978-0-444-63269-2.00068-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Mihi B, Van Meulder F, Rinaldi M, Van Coppernolle S, Chiers K, Van den Broeck W, Goddeeris B, Vercruysse J, Claerebout E, Geldhof P. Analysis of cell hyperplasia and parietal cell dysfunction induced by Ostertagia ostertagi infection. Vet Res 2013; 44:121. [PMID: 24330735 PMCID: PMC3878833 DOI: 10.1186/1297-9716-44-121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/29/2013] [Indexed: 02/07/2023] Open
Abstract
Infections in cattle with the gastric nematode Ostertagia ostertagi are associated with decreased acid secretion and profound physio-morphological changes of the gastric mucosa. The purpose of the current study was to investigate the mechanisms triggering these pathophysiological changes. O. ostertagi infection resulted in a marked cellular hyperplasia, which can be explained by increased transcriptional levels of signaling molecules related to the homeostasis of gastric epithelial cells such as HES1, WNT5A, FGF10, HB-EGF, AREG, ADAM10 and ADAM17. Intriguingly, histological analysis indicated that the rapid rise in the gastric pH, observed following the emergence of adult worms, cannot be explained by a loss of parietal cells, as a decrease in the number of parietal cells was only observed following a long term infection of several weeks, but is likely to be caused by an inhibition of parietal cell activity. To investigate whether this inhibition is caused by a direct effect of the parasites, parietal cells were co-cultured with parasite Excretory/Secretory products (ESP) and subsequently analyzed for acid production. The results indicate that adult ESP inhibited acid secretion, whereas ESP from the L4 larval stages did not alter parietal cell function. In addition, our data show that the inhibition of parietal cell activity could be mediated by a marked upregulation of inflammatory factors, which are partly induced by adult ESP in abomasal epithelial cells. In conclusion, this study shows that the emergence of adult O. ostertagi worms is associated with marked cellular changes that can be partly triggered by the worm’s Excretory/secretory antigens.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peter Geldhof
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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Corey KE, Gupta NK, Agarwal S, Xiao HD. Case records of the Massachusetts General Hospital. Case 32-2013. A 55-year-old woman with autoimmune hepatitis, cirrhosis, anorexia, and abdominal pain. N Engl J Med 2013; 369:1545-53. [PMID: 24131180 DOI: 10.1056/nejmcpc1208153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nardo GD, Oliva S, Aloi M, Ferrari F, Frediani S, Marcheggiano A, Cucchiara S. A pediatric non-protein losing Menetrier's disease successfully treated with octreotide long acting release. World J Gastroenterol 2012; 18:2727-2729. [PMID: 22690084 PMCID: PMC3370012 DOI: 10.3748/wjg.v18.i21.2727] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 08/13/2011] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
Pediatric Menetrier's disease (MD) is an uncommon, acute, self-limited hypertrophic gastropathy characterized by enlarged gastric folds associated with epithelial hyperplasia and usually accompanied by protein losing gastropathy. Gastric cytomegalovirus infection is found in one third of MD children and its treatment is often associated with remission. Diagnosis often requires full-thickness biopsy due to inability to detect typical histological findings with conventional endoscopic biopsy. We report an uncommon case of non self-limited pediatric MD needing endoscopic mucosal resection for diagnosis which was then successfully treated with octreotide long-acting release (LAR). To the best of our knowledge, this is the first pediatric MD case successfully treated with octreotide LAR. Our experience suggests octreotide LAR as treatment for refractory MD before gastrectomy.
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Fiori R, Velari L, Di Vito L, Della Gatta F, Bianchi M, Capurso L, Simonetti G. Ménétrier's disease diagnosed by enteroclysis CT: a case report and review of the literature. ACTA ACUST UNITED AC 2012; 36:689-93. [PMID: 21249356 DOI: 10.1007/s00261-011-9689-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study reports a case of Ménétrier's disease (MD) in an adult who presented with epigastric pain and peripheric edema. We focused in particular on the imaging and diagnostic aspects of the presenting case as well as clinical, histologic, and therapeutic aspects. Computed tomography (CT) enteroclysis is a new imaging technique which combines enteroclysis and spiral multislice CT. To the best of our knowledge this is the first report on a MD in an adult patient diagnosed by CT Enteroclysis.
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Affiliation(s)
- R Fiori
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University Hospital Tor Vergata, Rome, Italy
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Reggiani Bonetti L, Losi L, Di Gregorio C, Bertani A, Merighi A, Bettelli S, Scuri M, Maiorana A. Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases. Scand J Gastroenterol 2011; 46:1228-35. [PMID: 21692711 DOI: 10.3109/00365521.2011.594083] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The study reviews the endoscopic and histological features of human cytomegalovirus (HCMV) infections of the upper gastrointestinal (UGI) tract. MATERIALS AND METHODS Clinical histories, endoscopic findings and bioptic specimens of 30 cases of HCMV infection of the UGI tract, diagnosed in a University Hospital in a 10-year period, were reviewed. In all cases, viral inclusion bodies were detected in routine histopathological sections and the diagnosis was confirmed with immunohistochemistry. RESULTS Six patients were HIV+, whereas four had received organ transplantations, one was affected by common variable immunodeficiency and four had a recent history of malignancy. No other pathologic condition was evidenced in the remaining 15 cases. Mucosal alterations were endoscopically observed in the stomach (19 cases), esophagus (9), cardias (6) and duodenum (1), and multiple organs being synchronously affected in five patients (3 HIV+, 2 with history of malignancy). The antropyloric area was the most frequently affected site. Single ulcers were detected in 11 cases and multiple ulcers in 8, whereas mucosal thickenings (in the form of localized thickenings, polyps or rugal hypertrophy) were present in 13 patients. Thickenings of the mucosa were detected only in the stomach. At histology, necrotic material and granulation tissue were associated with moderate or marked lympho-plasmacytic infiltrate and foveolar hyperplasia in ulcerative lesions, whereas lesions labeled as mucosal thickenings showed mild or moderate chronic inflammatory infiltrate and foveolar hyperplasia. CONCLUSIONS Endoscopic manifestations of UGI tract involvement in HCMV infection are not specific, varying from erythematous mucosa to ulcers to mucosal thickenings.
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Affiliation(s)
- Luca Reggiani Bonetti
- Section of Pathologic Anatomy, Azienda Ospedaliera-Universitaria, Policlinico, Modena, Italy.
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Cytomegalovirus infection presenting as isolated inflammatory polyps of the gastrointestinal tract. Pathology 2011; 43:440-6. [DOI: 10.1097/pat.0b013e3283485e51] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Engjom T, Larsen KK, Hove O, Gilja OH. [A young man with acute, generalised oedema]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1627-9. [PMID: 20805862 DOI: 10.4045/tidsskr.09.0771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Ménétrier disease is an uncommon, idiopathic disease characterized by development of chronic protein loss from marked gastric foveolar hyperplasia. A literature search identified several reports of self-limiting, cytomegalovirus-associated Ménétrier disease in children. Some cases have also been reported in adults. CASE REPORT A formerly healthy man was admitted to hospital with a serum albumin level of 11 g/l and generalised oedema. Transabdominal ultrasound and endoscopy revealed a folded thickening of the (abdominal) ventricular wall; indications of Ménétrier disease. Histological examination of endoscopic biopsies showed moderate hyperplasia in foveolar epithelium, but also suggested an infectious cause. Intranucleal inclusion bodies, CMV-specific immunology, PCR and special stains all supported cytomegalovirus infection. The patient recovered quickly on antiviral treatment. CONCLUSION Our case demonstrates that cytomegalovirus may cause severe, Ménétrier-like gastritis with protein loss in non-immune-compromised adults.
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Affiliation(s)
- Trond Engjom
- Gastroseksjonen, Medisinsk avdeling, Haukeland universitetssykehus, 5021 Bergen, Norway.
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Abstract
Ménétrier's disease, a rare hyperproliferative disorder of the stomach, is associated with chronic abdominal pain, vomiting, weight loss, and edema, as well as an increased risk of gastric cancer. Therapy, other than surgical resection of the stomach, is limited to supportive measures and reflects the limited understanding of Ménétrier's disease pathogenesis. Data reported in this issue describe a promising targeted therapeutic approach and provide new insight into the causes of Ménétrier's disease.
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Affiliation(s)
- Sam C Nalle
- Department of Pathology, University of Chicago, Chicago, IL, USA
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Lauwers GY, Fujita H, Nagata K, Shimizu M. Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons. J Gastroenterol 2010; 45:131-45. [PMID: 19967418 DOI: 10.1007/s00535-009-0146-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 02/04/2023]
Abstract
The development of modern endoscopic techniques, easier and greater access to healthcare, and interest in Helicobacter pylori infection and its implications have all led to a significant increase in upper endoscopies. In turn, gastroenterologists and pathologists have been recognizing an ever-increasing number of patterns of mucosal injury. Consequently, there is now an interest in a wider aspect of non-neoplastic gastric pathology, namely, non-HP (H. pylori) gastritis. In this review, we present major clinico-pathological entities, based on either the salient morphological features or the underlying etiologies.
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Affiliation(s)
- Gregory Y Lauwers
- Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street WRN 2, Boston, MA 02114-2696, USA.
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Lauwers G, Mino-Kenudson M, Kradin RL. Infections of the Gastrointestinal Tract. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2010. [PMCID: PMC7152102 DOI: 10.1016/b978-1-4160-3429-2.00009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fiske WH, Tanksley J, Nam KT, Goldenring JR, Slebos RJC, Liebler DC, Abtahi AM, La Fleur B, Ayers GD, Lind CD, Washington MK, Coffey RJ. Efficacy of cetuximab in the treatment of Menetrier's disease. Sci Transl Med 2009; 1:8ra18. [PMID: 20368185 PMCID: PMC3638759 DOI: 10.1126/scitranslmed.3000320] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ménétrier's disease is a rare premalignant disorder of the stomach with no proven effective medical therapy. Increased epidermal growth factor receptor signaling has been implicated in the pathogenesis of Ménétrier's disease. We conducted a single-arm clinical trial with cetuximab, a monoclonal antibody that blocks epidermal growth factor receptor signaling, in nine individuals with clinically and histologically documented severe Ménétrier's disease that impaired quality of life to the extent that gastrectomy was being considered. Of the seven patients who completed the 1-month course of treatment, all showed statistically significant improvement both clinically (quality-of-life indices) and biochemically (increased parietal cell mass and gastric acidity). Furthermore, all seven patients who completed the 1-month trial elected to continue treatment, and four subsequently showed near-complete histological remission. Cetuximab should be considered as first-line therapy for Ménétrier's disease.
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Affiliation(s)
- William H Fiske
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Alanazi AH, Aldekhail WM, Jewell L, Huynh HQ. Multiple large gastric ulcers as a manifestation of cytomegalovirus infection in a healthy child. J Pediatr Gastroenterol Nutr 2009; 49:364-7. [PMID: 19252448 DOI: 10.1097/mpg.0b013e31818255a9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Aziz H Alanazi
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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28
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Megged O, Schlesinger Y. Cytomegalovirus-associated protein-losing gastropathy in childhood. Eur J Pediatr 2008; 167:1217-20. [PMID: 18651176 DOI: 10.1007/s00431-008-0791-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/25/2008] [Indexed: 01/28/2023]
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.
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Affiliation(s)
- O Megged
- Department of Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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29
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Lamps LW. Infectious disorders of the upper gastrointestinal tract (excluding Helicobacter pylori ). ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mpdhp.2008.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Menetrier's disease coexisting with ulcerative colitis and sclerosing cholangitis. Dig Liver Dis 2008; 40:78-9. [PMID: 18037066 DOI: 10.1016/j.dld.2007.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 10/08/2007] [Accepted: 10/12/2007] [Indexed: 12/11/2022]
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31
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Ghabril M, Gross S, Krishna M, Raimondo M. Hyperplastic Polyposis following Treatment of Gastric Vascular Ectasia: A Case Report and Review of Clinical Correlates. Case Rep Gastroenterol 2007; 1:48-52. [PMID: 21487471 PMCID: PMC3073787 DOI: 10.1159/000105560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The etiology of gastric antral vascular ectasia (GAVE) and hyperplastic polyps (HP) is not fully understood, but there is no known overlap. We report a case of gastroduodenal HP arising in a patient treated for GAVE.
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Affiliation(s)
- M Ghabril
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla., USA
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32
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Tokuhara D, Okano Y, Asou K, Tamamori A, Yamano T. Cytomegalovirus and Helicobacter pylori co-infection in a child with Ménétrier disease. Eur J Pediatr 2007; 166:63-5. [PMID: 16858581 DOI: 10.1007/s00431-006-0183-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Revised: 05/08/2006] [Accepted: 05/09/2006] [Indexed: 01/19/2023]
Abstract
Ménétrier disease, which is characterized by gastric rugal hypertrophy and hypoproteinemia secondary to a protein-losing gastroenteropathy, is uncommon in childhood. In this report we present the first case of Ménétrier disease in a child with co-infection of cytomegalovirus (CMV) and Helicobacter pylori (H. pylori).
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Affiliation(s)
- Daisuke Tokuhara
- Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka 545-8585, Japan.
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33
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Merchant JL. Tales from the crypts: regulatory peptides and cytokines in gastrointestinal homeostasis and disease. J Clin Invest 2007; 117:6-12. [PMID: 17200701 PMCID: PMC1716224 DOI: 10.1172/jci30974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The gastrointestinal (GI) tract is composed of a diverse set of organs that together receive extracorporeal nutrition and convert it to energy substrates and cellular building blocks. In the process, it must sort through all that we ingest and discriminate what is useable from what is not, and having done that, it discards what is "junk." To accomplish these many and varied tasks, the GI tract relies on endogenous enteric hormones produced by enteroendocrine cells and the enteric nervous system. In many instances, the mediators of these tasks are small peptides that home to the CNS and accessory gut organs to coordinate oral intake with digestive secretions. As the contents of ingested material can contain harmful agents, the gut is armed with an extensive immune system. A breach of the epithelial barrier of the GI tract can result in local and eventually systemic disease if the gut does not mount an aggressive immune response.
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Affiliation(s)
- Juanita L Merchant
- Division of Gastroenterology, Department of Internal, University of Michigan, Ann Arbor, Michigan, USA.
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34
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Cardona Barberán A, Sorní Hubrecht A, Hostalot Abás A, Rosal Roig J, Mercé Gratacós J, Izuel Navarro JA. [Ménétrier's disease of childhood and acute cytomegalus virus infection]. An Pediatr (Barc) 2006; 64:478-80. [PMID: 16756891 DOI: 10.1157/13087878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Menetrier's disease of childhood, or protein-losing hypertrophic gastropathy, is a rare entity of unknown etiology, characterized by hypertrophy of the gastric mucosa as well as secondary protein loss. Most published cases are associated with infection, mainly viral. These infections could alter the factors regulating growth and the function of gastric cells. In children, the disease is mild and resolved within a few weeks. We present the case of a 15-month-old child with a 72-hour history of intractable vomiting, hypoproteinemia and generalized progressive edema. We describe the characteristics of this case, as well as the clinical, ultrasonographic and endoscopic findings required for a diagnosis of this disease.
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Affiliation(s)
- A Cardona Barberán
- Servicios de Pediatría, Hospital Verge de la Cinta, Tortosa, Tarragona, España.
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35
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36
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Herman TE, McAlister WH. Gastrointestinal and renal abnormalities in cardio-facio-cutaneous syndrome. Pediatr Radiol 2005; 35:202-5. [PMID: 15490149 DOI: 10.1007/s00247-004-1306-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Revised: 07/08/2004] [Accepted: 07/29/2004] [Indexed: 10/26/2022]
Abstract
Cardio-facio-cutaneous syndrome (CFC) is an uncommon autosomal recessive condition recently distinguished from Noonan syndrome but with more marked growth failure and ectodermal dysplasia. Abdominal symptoms are frequently described but anatomic lesions in CFC have rarely been described. We have found significant anatomic abnormalities in CFC patients including antral foveolar hyperplasia, severe constipation with fecal impaction, nephrocalcinosis and renal cysts.
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Affiliation(s)
- Thomas E Herman
- St. Louis Children's Hospital, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110, USA.
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37
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Affiliation(s)
- Bryan T Green
- Division of Gastroenterology, Duke University Medical Center, Box 3913, Durham, NC 27710, USA
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Konstantinidou AE, Morphopoulos G, Korkolopoulou P, Eftychiadis C, Stamokosta E, Saetta A, Agapitos E. Menetrier disease of early infancy: a separate entity? J Pediatr Gastroenterol Nutr 2004; 39:177-82. [PMID: 15269624 DOI: 10.1097/00005176-200408000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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39
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Maiorana A, Baccarini P, Foroni M, Bellini N, Giusti F. Human cytomegalovirus infection of the gastrointestinal tract in apparently immunocompetent patients. Hum Pathol 2004; 34:1331-6. [PMID: 14691920 DOI: 10.1016/j.humpath.2003.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Human cytomegalovirus (HCMV) infection is usually reported in immunocompromised patients. This study reports 11 cases of HCMV infection of the gastrointestinal (GI) tract diagnosed in apparently immunocompetent hosts. The median age of the patients studied was 76 years, and the major presenting symptoms were diarrhea, epigastric pain, and abdominal discomfort. The large intestine was involved in 6 cases, the stomach in 4 cases, and the lower esophagus in 1 case. Endoscopy revealed ulcers or hypertrophic folds in the GI tract and single ulcers or erosions in the colon and rectum. Light microscopy showed chronic inflammatory infiltrate in the lamina propria in all cases. The diagnosis of HCMV infection was based on the histological and immunohistochemical identification of HCMV inclusion bodies in different cell types, including epithelial, endothelial, stromal, and smooth muscle cells. Both "classical" inclusions, characterized by an "owl's eye" appearance, and atypical inclusions were found. For all patients, no apparent causes of immunodeficiency were detected at the time of diagnosis of HCMV infection. At follow-up, however, 4 patients were found to harbor a malignant tumor (ie, pancreas, lung, Vater's papilla, and extrahepatic bile duct) at an interval of 2 to 5 months after the diagnosis of HCMV infection. Especially in elderly patients, HCMV infection of the GI tract might be an early clue to the presence of immunologic defects induced by an underlying neoplasia.
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Affiliation(s)
- Antonio Maiorana
- Department of Morphological and Forensic Sciences, Pathological Anatomy Section, University of Modena, Italy
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40
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Mirković D, Doder R, Ilić S, Mitrović M, Ignjatović M. Ménétrier's disease associated with ulcerative collitis. VOJNOSANIT PREGL 2003; 60:747-51. [PMID: 14737896 DOI: 10.2298/vsp0306747m] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In this paper a 21 year old patient was presented with M?n?trier's disease, associated with ulcerative colitis. The first symptoms of ulcerative colitis occured at the age of eleven, since when the patient has been conservatively treated several times because of the exacerbations of the desease. During control examinations presence of polipoid changes in stomach was discovered by upper endoscopy. Gastrectomy was suggested because the patient had excessive anemic syndrome which required weekly substitutional therapy with deplasmatic eritrocytes, as well as hypoproteinemia, while multiple polipoid changes suspect for malignancy were gastroscopically identifided. Patient accepted surgical treatment, and was transfered to the Clinic of Surgery. Total gastrectomy was performed, and patohystological finding confirmed M?n?trier's desease. After two weeks, the patient was released from the hospital in good general condition, with regular clinical and laboratory findings.
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Affiliation(s)
- Darko Mirković
- Vojnomedicinska akademija, Klinika za opstu i vaskularnu hirurgiju, Beograd
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41
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Abstract
The purpose of this review is to highlight two types of gastritis that have recently received much greater attention: lymphocytic gastritis and the gastritis associated with Crohn's disease. Lymphocytic gastritis is a distinctive pattern of inflammation that resembles that seen in celiac disease and lymphocytic colitis. It is associated with a diverse and unusual group of disorders in their own right, as well as having a possible relationship (real or phantom) with H. pylori infection. With respect to Crohn's disease, there is a growing recognition that, much more common than gastric granulomas, is the existence in one third or more of patients of a highly focal non-H. pylori gastritis. This recognition may help secure the diagnosis of Crohn's disease where it is equivocal, especially in children, in whom follow-up radiography and endoscopy cannot be done as readily as in adults.
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Affiliation(s)
- W M Weinstein
- Center for Health Sciences, University of California, Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90024, USA.
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