Angiokeratoma corporis diffusum (AKCD) is a dermatological hallmark of several inherited lysosomal storage disorders, including Anderson-Fabry disease, -galactosidosis, fucosidosis, aspartylglucosaminuria, galactosialidosis, -mannosidosis, and Kanzaki disease (1-3).A 50-year-old Japanese woman, the product of a consanguineous marriage, was admitted to our hospital for repeated respiratory tract infections and chronic heart failure due to hypertrophic obstructive cardiomyopathy. She had short stature, gargoyle-like appearance, mental retardation, anhidrosis, and AKCD from the lower back to bilateral femora (Fig. 1). With regard to her family history, her younger sister died suddenly in her third decade and her 54-year-old elder sister, who is still alive, also shows the same physical appearance, mental impairment, and AKCD. Lysosomal glycoaminoacid storage disease with AKCD was then considered, and enzyme examination of their leukocytes revealed -L-fucosidase deficiency. Fucosidosis is a rare, autosomal recessive disorder that results from the deficient activity of -L-fucosidase and the accumulation of fucose-containing glycosphingolipids, glycoproteins, and oligosaccharides in the lysosomes of the liver, brain, and other organs (4). There is wide variability in the clinical phenotype, with the most severely affected patients showing rapid progressive neurological deterioration, leading to decerebration and death in childhood (type I) (5), severe spondylo-