Educational Corner of the Issue

A 1 year old male infant is brought to the pediatrician by his mother because of a copious nasal discharge and developmental delay. He is noted to have coarse features with thick lips, a large tongue, a large bulging head and a flattened nose. On examination he is found to have an enlarged liver and spleen. His perinatal history was unremarkable. He was born by normal vaginal delivery and was examined and thought to be normal at birth.