General Appearance and Growth
Children with MPS VI generally present with macrocephaly and progressively dysmorphic facial
features. The overall appearance is similar to MPS I:1,2
- macrocephaly
- prominent forehead
- prominent eyes
- broad nose and low nasal bridge
- thick lips
- enlarged tongue
- hyperplastic gums and small, widely spaced teeth
Other manifestations of MPS VI include the following:1-6
- short stature
- shortened trunk
- crouching, flexed-knee stance
- protuberant abdomen
- arched back
- flexion contratures of the hand or hands that are short and broad, with short,
thick fingers 2,3
- waddling gait and toe walking 1,4,5
Although children with MPS VI initially exhibit normal or even accelerated growth rates, growth gradually decelerates,
and in patients with rapidly advancing disease, has stopped altogether by the age of 6 or 8 years.
Individuals with rapidly advancing disease exhibit extreme short stature, reaching maximum
heights between 110 and 140 cm (43 to 55 inches). Individuals with slowly advancing disease
reach final heights of 160 to 170 cm (63 to 67 inches).1,3,5-7
MPS VI patients exhibit poor exercise capacity, probably from a variety of causes, including
cardiopulmonary involvement, respiratory compromise, and musculoskeletal constraints.1
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 |
Short Stature and Flexed-Knee Stance. Seen with
coarse facies in a 16-year-old
male with rapidly advancing
disease (left). A 3-year-old with
slowly advancing disease does
not exhibit such obvious
features (right). |
| Photo courtesy of The National MPS Society, Inc. (right) |
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Dysmorphic Facial Features. Broad
nose, flat nasal bridge,
enlarged tongue and lips, and
macrocephaly, seen in a 12-year-old female with rapidly
advancing disease (left). A 6-year-old male with more slowly
advancing disease exhibits very
subtle facial coarsening (right). |
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 |
 |
Claw Hand Deformity. Short
fingers with fixed flexion and
poor dexterity, seen in a 16-year-old with rapidly advancing
disease (left). A 5-year-old
earlier in the course of the
disease exhibits less severe
finger flexion (right). |
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 |
 |
Short Stature. Short stature of
3 individuals with MPS VI, age
12 (left), age 16 (middle,
seated), and age 31 (right,
seated) is obvious relative to 2
unaffected relatives (rear).
Reliance on mobility aids, such
as the motorized carts seen
here, is common in MPS VI
patients—a result of poor
exercise capacity.1-3 |
- Neufeld EF, Muenzer J. The mucopolysaccharidoses. In: Scriver CR, Beaudet AL, Sly WS, Valle D,
eds. The Metabolic and Molecular Bases of Inherited Disease. Vol 3. 8th ed. New York, NY: McGraw-
Hill; 2001:3421-3452.
- Miller G, Partridge A. Mucopolysaccharidosis type VI presenting in infancy with endocardial
fibroelastosis and heart failure. Pediatr Cardiol. 1983;4:61-62.
- Whitley CB. The mucopolysaccharidoses. In: Beighton P, ed. McKusick's Heritable Disorders of
Connective Tissue. 5th ed. St Louis, Mo: Mosby; 1993:367-499.
- Spranger JW, Koch F, McKusick VA, et al. Mucopolysaccharidosis VI (Maroteaux-Lamy's disease).
Helv Paediatr Acta. 1970;25:337-362.
- Kakkis ED, Neufeld EF. The mucopolysaccharidoses. In: Berg BO, ed. Principles of Child Neurology.
New York, NY: McGraw-Hill; 1996:1141-1165.
- Heron D, Baumann C, Benichou JJ, Harpey JP, Le Merrer M. Early diagnosis of Maroteaux-Lamy syndrome in two patients with accelerated growth and
advanced bone maturation. Eur J Pediatr. 2004;163 (6) :323326.
- Sweidler SJ, Beck M, Bajbouj M, et al. Thres hold effect of urinary glycosaminoglycans and the walk
test as indicators of disease progression in a survey of subjects with mucopolysaccharidosis VI
(Maroteaux-Lamy syndrome). Am J Med Genet; 2005; 134; 144-150.
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