We report the case of a pre-school girl aged 5 years 11 months.
Weight at admission 21.4 kg, body surface area 0.83 m2.
The weight and height development prior to admission and growth curves were normal for their age and sex.
Three weeks before admission, the patient developed odynophagia, fever of 39°C, and left pleural edema.
She was evaluated in primary care and was diagnosed with bacterial pharyngitis indicating treatment with amoxicillin and NSAIDs.
On the third day of treatment bipalpebral oedema appeared.
Initially, edema was attributed to allergic reaction and desloratadine was indicated.
Episodes with increased abral edema added to abdominal disfunction, lower limb edema, general condition and colic-like abdominal pain.
Laboratory tests revealed hypoalbuminemia of 1.36 g/dl and leukocyte count of 17.500/mm3.
The patient was hospitalized with a diagnosis of edematous syndrome and suspicion of nephrotic syndrome.
Complete blood count, urea, creatinine, CRP and ESR, total proteins and proteins in blood, lipid profile, chest X-ray and urine test were requested, with no significant findings.
The result of proteinuria collected during 24 h was normal, so the initial suspicion of nephrotic syndrome was ruled out and the study of other causes of hypoalbuminemia began.
Since liver function tests were normal, the possibility of protein loss via the digestive route was considered.
Abdominal ultrasound, upper gastrointestinal endoscopy and CMV antibodies were requested.
Abdominal ultrasound showed enlarged spleen 108 mm without ascites.
Upper gastrointestinal endoscopy revealed an extensive depressed and hyperemic area in the gastric body with islands of pink-titrated tissue.
Much acartonated and friable.
Only two thick folds were observed, the antral mucosa was preserved.
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The endoscopic report concluded: "Signature of Menetrier's Disease, Adenocarcinoma or gastric lymphoma".
The urease test for HP was positive.
IgG for CMV was 21.1 EU/ml (positive).
The gastric biopsy showed mild chronic gastritis, without metaplasia, dysplasia or malignancy.
Due to suspicion of nephrotic syndrome, exogenous albumin, furosemide, prednisone and ranitidine were administered and suspended 48 h later.
On the third day, there was a decrease in lower limb edema, recovery of albumin and improvement in general condition.
This clinical improvement corresponded to spontaneous remission of this disease described in children.
He did not suffer ulceration.
A follow-up endoscopy performed one week later revealed clear recovery of the mucosa with the presence of some eroded thickened folds.
On day 14 of hospitalization, she was discharged in good general condition with a weight of 19.1 kg. A high protein diet and esomeprazole 20 mg/day were prescribed.
One month later, the asymptomatic girl presented elevated small lesions with pseudopolyps.
Albuminemia was 4.3 g/dl, maintaining a weight of 19.7 kg. Six months after the asymptomatic patient was discharged with a weight of 21.5 kg. At eight months the normal mucosa control was performed an end mucosa.
