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Published on: August 8, 2022
Hunter syndrome with its typical heart: a close mimic to rheumatic heart
Jagadesh Madireddi1, Sarada P1, R K Shetty2
1Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India.
Insights
Hunter syndrome, a rare genetic disorder, presents with multisystem involvement and cardiac issues. Early diagnosis and enzyme replacement therapy significantly improve patient quality of life.
Area of Science:
- Biochemistry
- Genetics
- Pediatrics
Background:
- Mucopolysaccharidoses (MPS) are rare genetic lysosomal storage disorders.
- Hunter syndrome (MPS II) is characterized by a deficiency in iduronate-2-sulfatase, leading to glycosaminoglycan accumulation.
- Multisystemic manifestations include skeletal deformities, coarse facial features, and cardiac valve abnormalities.
Observation:
- A 24-year-old male presented with dyspnea (New York Heart Association grade 3), dwarfism, coarse facial features, and multiple skeletal deformities (cubitus valgus, claw hand, genu valgus, hallux valgus, equinovarus).
- Systemic examination revealed cardiomegaly, a pansystolic mitral regurgitation murmur, hepatosplenomegaly, and normal intelligence.
- Echocardiography demonstrated thickened mitral and aortic valves with moderate mitral regurgitation.
Findings:
- Clinical presentation and echocardiographic findings suggested a storage disorder, specifically mucopolysaccharidosis, due to characteristic cardiac involvement.
- Further investigations confirmed the diagnosis of Hunter syndrome (MPS II).
Implications:
- Hunter syndrome requires consideration in young patients presenting with multisystemic involvement and cardiac abnormalities.
- Availability of enzyme replacement therapy (ERT) underscores the importance of early diagnosis and prompt, multidisciplinary treatment.
- Timely intervention can significantly improve the quality of life for individuals with Hunter syndrome.
Abstract:
A 24-year-old man presented with New York Heart Association (NYHA) grade 3 dyspnoea. He appeared dwarf-like with coarse facial features. General examination revealed cubitus valgus, claw hand, genu valgus, hallus valgus and equinovarus deformity of the foot. Systemic examination revealed cardiomegaly, a pansystolic mitral regurgitation (MR) murmur, hepatosplenomegaly and a normal IQ. Examination suggested multisystem disease involving the dermatological, musculoskeletal, cardiac and gastrointestinal system. Echocardiography showed thickened mitral and aortic valves, and moderate MR. We considered this as a storage disorder, particularly the mucopolysaccharidosis, because of its typical cardiac involvement. Further evaluation confirmed the diagnosis of Hunter syndrome. The patient was considered for enzyme replacement therapy, following which he improved. This rare disease must be considered whenever a physician encounters a young patient with multisystem involvement. In view of the availability of disease-specific therapy, an early diagnosis and prompt treatment with a multidisciplinary approach can improve the quality of life of these patients.
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