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Introdução: Mucopolissacaridose tipo IV (MPS IV) é uma doença hereditária autossômica recessiva de armazenamento lisossômico devido a mutações no gene N-acetilgalactosamina-6-sulfatase (GALNS). Sua incidência é de 1 em 75.000 a 1 em 200.000 nascimentos, com distribuição igual em homens e mulheres (1). O diagnóstico é baseado em manifestações clínicas, achados radiológicos, testes bioquímicos e detecção molecular. Infelizmente, não há cura para MPS IVA; embora terapias experimentais tenham sido implementadas recentemente e novos tratamentos estejam em desenvolvimento.


Apresentação do caso: Serão apresentados dois pacientes irmãos com diagnóstico tardio de Mucopolissacaridose tipo IVA, os primeiros 41 anos, sexo feminino com manifestações esqueléticas como cifoescoliose, osteocondrodisplasia C2/C3, pectus carinatum, doença de Perthes bilateral, pés planos e limitações esqueléticas, amplitude de movimento e marcha, apneia obstrutiva do sono, características faciais atípicas e baixa estatura. O segundo, 41 anos, sexo masculino, fronte larga, nariz côncavo, alterações dentárias, cifoescoliose, pectus carinatum, extremidades encurtadas, dor ao movimentar as mãos, marcha limitada e pés chatos. Em ambos, uma variante homozigótica no gene GALNS de significado clínico incerto (VUS) foi identificada no exoma, c.850 T>G p. (Phe284Val).


Discussão: A mucopolissacaridose tipo IVA é uma doença heterogénea com um espectro diverso. Nossos casos contribuem para a literatura local e internacional por apresentarem manifestações clínicas e esqueléticas típicas dessa patologia, bem como confirmação diagnóstica molecular.

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