Marked gastric foveolar hyperplasia associated with active cytomegalovirus infection

Transient protein-losing gastropathy with marked gastric rugal hypertrophy, a Menetrier's disease-like process, is an uncommon condition of unknown etiology. Most of these cases have been reported in pediatric patients; the clinical course is usually favorable. Cytomegalovirus infection has been implicated as a possible etiology in many of the reported cases. This type of Ménétrier's-like disease has not been well documented in adult patients. We describe here an elderly man who presented with severe protein-losing gastropathy and large polypoid nodules in the stomach. Gastric mucosal biopsies revealed marked gastric foveolar hyperplasia with morphological evidence of cytomegalovirus (CMV) infection. Immunohistochemical analysis demonstrated an aberrant topographic distribution of staining for transforming growth factor-alpha and transforming growth factor-beta receptor II, as described in other cases of Ménétrier's disease in the literature. This transient Ménétrier's-like disease associated with CMV infection should be considered in the differential of both pediatric and adult patients with GI protein loss.