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Orthopedic abnormalities in an 8-year-old patient with Sanfilippo A disease: A case report

Sanfilippo syndrome (mucopolysaccharidosis III – MPS III) is a rare genetic disease characterised by progressive neurodegeneration caused by uncontrolled lisosomal and intercellular space glycosaminoglycans (GAGs) accumulation. The disorder occurs after several years of proper child development and is related to changes in nervous, gastrointestinal, cardiovascular, respiratory, visual, auditory and musculoskeletal systems. The authors present orthopaedic abnormalities in an 8-year-old patient with Sanfilippo disease and discuss recommendation for medical intervention of skeletal deformations in patients suffering from Sanfilippo disease. Case presentation: an 8-year-old girl with Sanfilippo disease is reported on. She was diagnosed at the age of 3 when the first abnormalities were revealed. At the age of 8, when orthopaedic problems occurred the physical examination presented characteristic features of MPS such as thickened facial lines, flat base of the nose and dry, light hair. In neurological examination she presented macrocephaly, decreased axial muscle tone and increased circumferential muscle tone, independent but impaired gait pattern. Orthopaedics examination and diagnostic procedures revealed coxa vara, knee valgum and Achilles tendon contraction. Conclusion: Sanfilippo syndrome is a rare genetic – autosomal recessive – disease belonging to the group of Lysosomal Storage Disorders (LSDs). After several years after the first symptoms of the disease abnormalities in musculoskeletal system are revealed. The most common orthopaedic procedures in these patients are carpal tunnel release, trigger-finger release and hip replacement. In each case the patient`s QoL and the high risk of surgery and anaesthesia should be balanced individually.