A136 MÉNÉTRIER’S DISEASE-LIKE PRESENTATION IN A PEDIATRIC PATIENT AS A FIRST PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS
Bibliographic record
Abstract
Abstract Background Ménétrier’s disease (MD) is an uncommon gastric disorder characterized by hypertrophic gastric mucosal folds, excess mucus secretion, and protein-losing gastropathy. It is mainly seen in adult patients, with around 100 pediatric cases reported to date, often associated with cytomegalovirus (CMV) infection. Systemic lupus erythematosus (SLE) is a autoimmune condition that can affect multiple systems. While MD and SLE are separately rare, there have been reports of MD preceding SLE in adult patients. However, no cases have documented MD as the initial presentation leading to a diagnosis of SLE in pediatric patients. Aims This case report aims to describe the first documented instance of a pediatric patient presenting with suspected Ménétrier’s disease, whose clinical course led to a diagnosis of systemic lupus erythematosus. Methods: Case Summary A 13-year-old boy with a history of autism spectrum disorder, presented with anasarca and multiple systemic symptoms, including musculoskeletal pain, fatigue, mouth ulcers, non-productive cough, and generalized edema. On admission, he was hypotensive with mild conjunctival injection, peri-orbital edema, ascites, and non-pitting edema in the lower limbs. Lab tests showed leukopenia, neutropenia, thrombocytopenia, elevated ferritin, and hypoalbuminemia. Imaging revealed bilateral pleural effusions and ascites, along with thickened gastric folds on CT scan raising suspicion for Ménétrier’s disease. An upper GI endoscopy showed atypical thick folds with scaliness in the stomach, but the biopsy was negative for H. pylori, CMV, showed no significant inflammation, no foveolar metaplasia, no viral cytopathic changes and had well-preserved morphology in esophageal, gastric and duodenal biopsies. A kidney biopsy was done in the context of proteinuria and confirmed lupus nephritis. Results He was diagnosed with systemic lupus erythematosus (SLE) and treated with steroids, Plaquenil, and Mycophenolate Mofetil. Post-treatment, his symptoms, including ascites and edema, resolved, and his lab values, such as blood counts, albumin, and C3/C4 levels, normalized. The patient showed significant clinical improvement following SLE-targeted therapy. Conclusions This case highlights the complexity and diagnostic challenges in differentiating Ménétrier’s disease from systemic lupus erythematosus, particularly when both disorders present with overlapping features. In addition, it suggests that in rare instances, MD may be a manifestation of a broader systemic inflammatory process such as SLE. Multidisciplinary approach and comprehensive evaluation are essential for accurate diagnosis and management in such complex cases. Funding Agencies None
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".