Diagnostic Dilemma

Mucopolysaccharidoses


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A 4-year-old boy 2nd born of third-degree consanguineous marriage presented with cough and breathlessness for 10 days. He was operated on for an inguinal hernia at 4 months of age and was treated for rickets in view of skeletal deformities. Milestones are normal. On examination, he had bronchospasm, a large head, short stature, dysostosis multiplex, umbilical hernia, corneal clouding, and hepatosplenomegaly. Other systems were normal. Chest X-Ray showed oar-shaped ribs and he had bullet-shaped phalanges. He was suspected of a case of Mucopolysaccharidoses (MPS). Echocardiography showed infiltrative cardiomyopathy with mild mitral valve and aortic valve prolapse with mitral regurgitation.

What additional complications should one screen for?
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