title: Atypical clinical presentation of mucopolysaccharidosis type II (Hunter syndrome): a case report.
abstract: BACKGROUND
  We present a very rare case of mucopolysaccharidosis with atypical presentation such as mild mental retardation, an acrocephalic head and no corneal clouding. The purpose of presenting this case is to highlight the distinctive manifestation of mucopolysaccharidosis type II (Hunter syndrome).
  
  
  METHODS
  A 10-year-old East Asian boy presented with abdominal distension of five years' duration and complained of shortness of breath on and off for the same period. On examination his head was large and his head circumference was 54.5 cm. His neck was short, he had coarse facial features, a depressed nasal bridge and small stubby fingers with flexion of distal interphalangeal joints, and a low arched palate was observed. There was mild mental retardation.
  
  
  CONCLUSIONS
  Based on clinical findings and radiological features it is possible to diagnose a case of mucopolysaccharidosis.Careful and systemic approach is needed to accurately diagnose the exact type as enzymatic studies are not available in most centers.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal. gaurishankarshah@hotmail.com.
authors.forename: Gauri Shankar
authors.initials: GS
authors.lastname: Shah
authors.forename: Tania
authors.initials: T
authors.lastname: Mahal
authors.forename: Subodh
authors.initials: S
authors.lastname: Sharma