“…EM examination may help to exclude Anderson–Fabry's disease, because this disease is the only one among metabolic diseases with ACD to show electron‐dense, lamellar (zebra‐like) inclusions within endothelial and other cell types 13,20 . By EM, it was observed that endothelial cells of fucosidosis angiokeratomas contain electron‐lucent vacuoles, found also in several other cell types, not only in the skin but in other tissues as well, including liver, 21,22 peripheral nerves, 23 rectal mucosa, 24 eye, 25 and peripheral lymphocytes 26 . The differential diagnosis between these ACD‐associated metabolic diseases is established through biochemical examination, showing greatly reduced or absent activity of the deficient enzyme within leukocytes, skin fibroblasts, or other tissues such as the liver.…”