Word Count：2387語 (Time: 13'09'', 182 wpm)
- Our patient presented with a clinical picture of viral infection and severe epigastric pain. Because he had ingested high doses of NSAIDs to control his fever, NSAID-induced gastritis was initially suspected as the cause of his abdominal pain. However, the finding of severe hypoalbuminemia was not easily explained by either viral infection or his NSAID use. The identification of this abnormality led to reconsideration of the working diagnosis and a shift from a “probability approach” (identifying the most likely diagnosis) to a “causal reasoning” approach (looking for clinical conditions that could underlie this finding as well as the other presenting symptoms and signs).
- Ménétrier's disease affects men more often than women and is most common between 40 and 55 years of age. Clinical manifestations of the disease include epigastric pain, weight loss, nausea, vomiting, gastrointestinal bleeding, diarrhea, and protein-losing gastropathy. Hypoalbuminemia is present in 20 to 100% of patients, according to a different series; this feature helps distinguish Ménétrier's disease from the Zollinger–Ellison syndrome.