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A child suffering from the cerebro-hepato-renal syndrome of Zellweger is presented. The clinical features are hypotonia, slow or absent feeding, profound psychomotor retardation, severe impairment of hearing, disturbed visual acuity and a characteristic facial appearance including high forehead and large fontanels. The biochemical abnormalities are disturbed liver function tests, increased concentration of pipecolic acid in serum, cerebrospinal fluid and urine, di- and trihydroxycoprostanic acid detectable in bile, serum and urine and an increased excretion of para-hydroxy-phenyllactate in urine.
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