A 16-year-old girl was admitted to a Chinese hospital complaining of swelling of her legs for two months without any other symptoms. She had no previous health problems. During the examination, swelling of the legs with the formation of a pit when pressing and slight swelling around the eyes were detected. Laboratory tests revealed a low level of albumin in the blood: 26 (with the norm being 38–54) grams per liter. Renal and liver function tests and a general urine analysis were normal. In search of the source of protein loss, the patient underwent a CT scan of the abdominal cavity, which determined diffuse thickening of the stomach walls with enlarged folds. Gastroscopy showed pronounced swelling of the folds of the stomach with nodularity, erosions of the mucous membrane and abundant yellow mucus. Doctors Xing Wang and Haifeng Liu from Shanghai Children's Hospital shared this case in the New England Journal of Medicine.
A gastric mucosal biopsy revealed foveolar hyperplasia with tortuous hypertrophic glands. Based on the examination results, the patient was diagnosed with Menetrier's disease, or giant hypertrophic gastritis. This is a rare disease of unknown etiology, which is characterized by hyperproliferation of the gastric epithelium, mucus hypersecretion and, as a result, gastropathy with the loss of a large amount of protein, leading to hypooncotic peripheral edema. It is usually detected in men aged 30-50 years, and the described case is very atypical. The girl was prescribed a high-protein diet, as well as a course of therapy to eradicate an accidentally detected Helicobacter pylori infection. On re-examination three months later, she did not have edema and hypoalbuminemia.