• Zeferino Demartini, Munhoz da Rocha GuimaraesRicardoRComplexo Hospital Pequeno Principe, Curitiba, Brazil., and Adriane A Cardoso-Demartini.
• Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil; Complexo Hospital Pequeno Principe, Curitiba, Brazil. Electronic address: demartiniz@gmail.com.
• World Neurosurg. 2021 Sep 1; 153: 41-43.

AbstractMorquio disease or mucopolysaccharidosis type IVA (Online Mendelian Inheritance in Man No. 253000) is a rare autosomal recessive disease classified in the group of metabolism inborn errors. The glycosaminoglycans accumulate in chondrocytes, which disturbs bone growth and leads to skeletal manifestations, such as skeletal dysplasia and a short stature. In addition, the disproportionate growth of the trachea can lead to airway insufficiency. We report the case of a 27-year-old man with dwarfism due to Morquio disease, which had resulted in quadriparesis, hyperreflexia, and dyspnea, requiring a "look up to the sky" compensatory position. Imaging studies of the neck showed tracheal tortuosity, spinal stenosis, myelopathy, and neurogenic arthropathy (Charcot joint). The patient was treated with occipital-cervical-thoracic instrumentation. However, postoperative tracheal correction was required. Considering the wide spectrum of clinical features in those with mucopolysaccharidosis type IVA, individualized multidisciplinary treatment is recommended.Copyright © 2021 Elsevier Inc. All rights reserved.

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