Ménétrier’s disease presenting as recurrent unprovoked venous thrombosis: a case report

Abstract

BackgroundAcquired thrombophilia is a potential sequela of malignancy, chronic inflammation, and conditions characterized by severe protein deficiency (for example, nephrotic syndrome, protein-losing enteropathy). As such, venous thrombosis is often a feature, and occasionally a presenting sign, of systemic disease. Ménétrier’s disease is a rare hyperplastic gastropathy that may lead to gastrointestinal protein loss and hypoalbuminemia. To date, reports of venous thrombosis associated with Ménétrier’s disease are exceedingly scarce.Case presentationWe report the case of a 40-year-old white man who presented with unprovoked deep venous thrombosis, pulmonary embolism, and renal vein thrombosis. Upon receiving therapeutic anticoagulation, he developed severe gastrointestinal bleeding, and endoscopic evaluation led to a diagnosis of Ménétrier’s disease. A laboratory workup revealed deficiency of protein C, protein S, and antithrombin III, as well as markedly elevated levels of factor VIII. He was determined to have an acquired thrombophilia as a direct result of Ménétrier’s disease.ConclusionsThis case describes an acquired thrombophilic state in a patient with Ménétrier’s disease and profound hypoalbuminemia. Although this association is rarely described, we discuss the probable mechanisms leading to our patient’s thrombosis. Specifically, we posit that his gastrointestinal protein loss led to a deficiency of several anticoagulant proteins and a compensatory elevation in factor VIII, as occurs in nephrotic syndrome and inflammatory bowel disease. Of note, this patient’s recurrent venous thrombosis was the initial clinical sign of his gastrointestinal pathology.

Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier’s disease with an underlying lipoma: A case report

“…The bleeding may present as hematemesis or, like in this case, as melena[ 10 , 11 ]. One patient developed deep vein thrombosis and received anticoagulation therapy, which led to gastrointestinal bleeding[ 12 ]. Iron deficiency anemia in patients with Ménétrier’s disease could be a sign of occult bleeding, but iron malabsorption should also be considered[ 13 , 14 ].…”

A Rare Case of Juvenile Polyposis Syndrome Mimicking Ménétrier's Disease

“…Patients are at risk of protein-loss, gastric-outlet, small-bowel, and esophageal obstruction. Interestingly, there have also been reports of acquired thrombophilia as a direct result [ 7 ]. Our patient developed an acute upper extremity deep venous thrombus, which may be linked to his underlying polyposis syndrome.…”

Menetrier’s disease: A rare diagnosis established by ultrasonography and computed tomography

“…Menetrier's disease has also a recognized premalignant potential although the precise risk of progression to gastric cancer is not known [4] . But the only satisfactory treatment has historically been and remains the surgical intervention with total or partial gastrectomy [5] . Menetrier's disease (MD) is a rare disease characterized by hypertrophic folds in the body of the stomach, foveolar hyperplasia, and hypoproteinemia due to the selective loss of serum proteins through the gastric mucosa [6] .…”