A 16-year-old girl was admitted to a Chinese hospital complaining of leg swelling for two months without any other symptoms. She had no previous health problems. Examination revealed swelling of the legs with pitting and slight puffiness around the eyes. Laboratory tests revealed low blood albumin levels: 26 grams per liter (with a normal range of 38–54). Renal and liver function tests and a urinalysis were normal. To determine the source of protein loss, the patient underwent an abdominal CT scan, which revealed diffuse thickening of the stomach walls with enlarged folds. A gastroscopy revealed marked swelling of the gastric folds with nodularity, mucosal erosions, 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 Ménétrier's disease, or giant hypertrophic gastritis. This rare disorder of unknown etiology is characterized by hyperproliferation of the gastric epithelium, mucus hypersecretion, and, consequently, protein-losing gastropathy, leading to hypooncotic peripheral edema. It is typically diagnosed in men aged 30 to 50 years; this case is highly atypical. The patient was prescribed a high-protein diet and a course of therapy to eradicate an incidental Helicobacter pylori infection. A follow-up examination three months later revealed no edema or hypoalbuminemia.
