Anemia and hypogammaglobulinemia caused by Ménétrier’s disease

Excerpt

A 13-year-old boy with anemia, identified during a health check-up at his junior high school, visited his primary physician clinic. His first laboratory results indicated a hemoglobin (Hb) level of 9.8 g/dL. After 2 months, a subsequent consultation with his primary physician showed that his Hb had decreased to 7.1 g/dL. Next, he presented at our hospital. His blood results revealed microcytic hypochromic anemia. Reticulocyte count was elevated to 29.23 × 10⁴/μL (normal range 3 × 10⁴–9 × 10⁴/μL). Serum iron level was 526 μg/dL (80–140 μg/mL), serum ferritin level was 137.8 ng/mL (39–765 ng/mL), vitamin B12 level was 503 pg/mL (233–914 pg/mL), folate level was 5.4 ng/mL (3.6–129 ng/mL), serum zinc level was 84 μg/dL (64–111 μg/dL), and serum copper level was 97 μg/dL (78–130 μg/dL). In addition, his erythropoietin level had increased to 43.9 mIU/mL (4.2–23.7). Although the patient did not report any episode of enteral bleeding, we suspected this based on his laboratory results. Gastroendoscopy revealed a fibrous mucoid coagulation in the stomach with enlarged gastric folds (Fig. 1). Atrophic mucosa suggested a Helicobacter pylori infection, and a biopsy of the hyperplastic mucosal lesion was performed. Histopathological examination did not reveal any malignancy. H. pylori was detected in the stomach. Cytomegalovirus (CMV) infection was not detected in the gastric mucosa. His immunoglobulin levels decreased to 543 mg/dL (normal range 870–1700 mg/dL). In addition, he exhibited mild hypoproteinemia, his total protein level was 6.4 g/dL, and serum albumin level was 4.1 g/dL. Anti-CMV antibody was negative. Therefore, Ménétrier’s disease was diagnosed. Protein-losing gastroenteropathy was confirmed by 99mTc-human serum albumin scintigraphy (Fig. 2), and stool was examined for α-1-antitrypsin. The daily volume of fecal α1-antitrypsin was 36.4 mg/day, and the clearance of fecal α1-antitrypsin was 29.1 ml/day (normal range 0–22 ml/day) [1]. Ménétrier’s disease is categorized as a protein-losing gastroenteropathy, and its pathogenesis is hypothesized to be associated with epidermal growth factor receptor. Eradication therapy was administered for H. pylori infection, and anemia did not recur. Therefore, Ménétrier’s disease should be recognized as a cause of anemia in adolescents and young adults.

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