D

Hurler syndrome (MPS I) classically presents in the first year with copious persistent nasal discharge, coarse facies, macroglossia, flattened nasal bridge, bulging head, and hepatosplenomegaly—exactly the constellation described. These findings are not typical of hypothyroidism, Beckwith-Wiedemann, or Proteus syndrome. [Wraith, 2014, PMID 25345091]