Abstract
Objective
The skeletal abnormalities of mucopolysaccharidosis (MPS) and skeletal dysplasia (SD) may be similar and even indistinguishable. This study aims to elucidate clinical clues and overlapping features that may assist in the different diagnosis.
Methods
The clinical features of patients who were first referred to endocrinology or rheumatology department for short stature or joint abnormalities were addressed and signs were examined upon different diagnosis.
Results
Three patients (I, II and III) were diagnosed with SD with overlapping and also distinguishing skeletal features compared with MPS. An atypical presentation defined in patient IV who was diagnosed with Morquio syndrome. Patients V and VI were diagnosed with MPS with early onset and typical skeletal features accompanied with additional systemic manifestations uncommon in SD.
Conclusion
In conclusion, this study emphasizes the clinical and radiological evaluation and nuances distinctions in clinical presentations that will highlight the challenges and guide to distinguishing different diagnosis of MPS and SD in atypical presentations for achieving the accurate diagnosis.
Keywords: Mucopolysaccharidosis, skeletal dysplasia, orthopedics, radiology, genetics
Read the full text
5 sections · 1 figure · 1 table · PDF
Create your free account to read the full text.
- Full text with figures and tables
- PDF and supplementary files
- Access on every Galenos journal
One Galenos account works on every Galenos journal site.
References
Neufeld EU, Muenzer J. The mucopolysaccharidoses. In: Scriver CR, ed. The metabolic and molecular bases of inherited disease. New York: McGraw-Hill, 2001:342152.
Muenzer J. Overview of the mucopolysaccharidoses. Rheumatology (Oxford). 2011;50(Suppl 5):-v12.
Mortier GR, Cohn DH, Cormier-Daire V, Hall C, Krakow D, Mundlos S, Nishimura G, Robertson S, Sangiorgi L, Savarirayan R, Sillence D, Superti-Furga A, Unger S, Warman ML. Nosology and classification of genetic skeletal disorders: 2019 revision. Am J Med Genet A. 2019;179:2393-2419. Epub 2019 Oct 21
Bhattacharya K, Balasubramaniam S, Choy YS, Fietz M, Fu A, Jin DK, Kim OH, Kosuga M, Kwun YH, Inwood A, Lin HY, McGill J, Mendelsohn NJ, Okuyama T, Samion H, Tan A, Tanaka A, Thamkunanon V, Toh TH, Yang AD, Lin SP. Overcoming the barriers to diagnosis of Morquio A syndrome. Orphanet J Rare Dis. 2014;9:192.
MacCarrick G, Aradhya S, Bailey M, Chu D, Hunt A, Izzo E, Krakow D, Mackenzie W, Poll S, Raggio C, Shediac R, White KK, McLaughlin HM, Seratti G. Clinical utility of comprehensive gene panel testing for common and rare causes of skeletal dysplasia and other skeletal disorders: results from the largest cohort to date. Am J Med Genet A. 2024;194:e63646. Epub 2024 May 3
Muenzer J. The mucopolysaccharidoses: a heterogeneous group of disorders with variable pediatric presentations. J Pediatr. 2004;144(5 Suppl):27-34.
Seaver LH, Irons M; American College of Medical Genetics (ACMG) Professional Practice and Guidelines Committee. ACMG practice guideline: genetic evaluation of short stature. Genet Med. 2009;11:465-470.
Collett-Solberg PF, Ambler G, Backeljauw PF, Bidlingmaier M, Biller BMK, Boguszewski MCS, Cheung PT, Choong CSY, Cohen LE, Cohen P, Dauber A, Deal CL, Gong C, Hasegawa Y, Hoffman AR, Hofman PL, Horikawa R, Jorge AAL, Juul A, Kamenický P, Khadilkar V, Kopchick JJ, Kriström B, Lopes MLA, Luo X, Miller BS, Misra M, Netchine I, Radovick S, Ranke MB, Rogol AD, Rosenfeld RG, Saenger P, Wit JM, Woelfle J. Diagnosis, genetics, and therapy of short stature in children: A Growth Hormone Research Society international perspective. Horm Res Paediat. 2019;92:1-14. Epub 2019 Sep 12
Dauber A, Rosenfeld RG, Hirschhorn JN. Genetic evaluation of short stature. J Clin Endocrinol Metab. 2014;99:3080-3092. Epub 2014 Jun 10
Vijay S, Wraith JE. Clinical presentation and follow-up of patients with the attenuated phenotype of mucopolysaccharidosis type I. Acta Paediatr. 2005;94:872-877.
Cimaz R, Coppa GV, Koné-Paut I, Link B, Pastores GM, Elorduy MR, Spencer C, Thorne C, Wulffraat N, Manger B. Joint contractures in the absence of inflammation may indicate mucopolysaccharidosis. Pediatr Rheumatol Online J. 2009;7:18.
Cimaz R, Vijay S, Haase C, Coppa GV, Bruni S, Wraith E, Guffon N. Attenuated type I mucopolysaccharidosis in the differential diagnosis of juvenile idiopathic arthritis: a series of 13 patients with Scheie syndrome. Clin Exp Rheumatol. 2006;24:196-202.
Lachman RS, Burton BK, Clarke LA, Hoffinger S, Ikegawa S, Jin DK, Kano H, Kim OH, Lampe C, Mendelsohn NJ, Shediac R, Tanpaiboon P, White KK. Mucopolysaccharidosis IVA (Morquio A syndrome) and VI (Maroteaux-Lamy syndrome): under-recognized and challenging to diagnose. Skeletal Radiol. 2014;43:359-369. Epub 2014 Jan 4
Montaño AM, Tomatsu S, Gottesman GS, Smith M, Orii T. International Morquio A registry: clinical manifestation and natural course of Morquio A disease. J Inherit Metab Dis. 2007;30:165-174. Epub 2007 Mar 8
Hendriksz CJ, Al-Jawad M, Berger KI, Hawley SM, Lawrence R, Mc Ardle C, Summers CG, Wright E, Braunlin E. Clinical overview and treatment options for non-skeletal manifestations of mucopolysaccharidosis type IVA. J Inherit Metab Dis. 2013;36(Suppl 2):309- 322. Epub 2012 Feb 23
Watson SG, Calder AD, Offiah AC, Negus S. A review of imaging protocols for suspected skeletal dysplasia and a proposal for standardisation. Pediatr Radiol. 2015;45:1733-1737. Epub 2015 Jun 17
Weiner DS, Guirguis J, Makowski M, Testa S, Shauver L, Morgan D. Orthopaedic manifestations of pseudoachondroplasia. J Child Orthop. 2019;13:409-416.
Gabra P, Jana M, Naranje P, Gupta N, Kabra M, Gupta AK, Yadav R. Spine radiograph in dysplasias: a pictorial essay. Indian J Radiol Imaging. 2020;30:436-447. Epub 2021 Jan 13
Miyoshi K, Nakamura K, Haga N, Mikami Y. Surgical treatment for atlantoaxial subluxation with myelopathy in spondyloepiphyseal dysplasia congenita. Spine (Phila Pa 1976). 2004;29:E488-E491.
Ransford AO, Crockard HA, Stevens JM, Modaghegh S. Occipito-atlanto-axial fusion in Morquio-Brailsford syndrome. A ten-year experience. J Bone Joint Surg Br. 1996;78:307-313.
Kozlowski K, John E, Masel J, Muralinath S, Vijayalakshmi G. Case report: neonatal platyspondylic dwarfism--a new form. Br J Radiol. 1995;68:1254-1256.
Lehman TJ, Miller N, Norquist B, Underhill L, Keutzer J. Diagnosis of the mucopolysaccharidoses. Rheumatology (Oxford). 2011;50(Suppl 5):V41-48.
Gajarajulu V, Natarajan B, Muralinath S. The radiograph of the pelvis as a window to skeletal dysplasias. Indian J Pediatr. 2016;83:543-552. Epub 2016 Jan 29
Lee NH, Cho SY, Maeng SH, Jeon TY, Sohn YB, Kim SJ, Park HD, Jin DK. Clinical, radiologic, and genetic features of Korean patients with mucopolysaccharidosis IVA. Korean J Pediatr. 2012;55:430-437. Epub 2012 Nov 23 Erratum in: Korean J Pediatr. 2013;56:143.


