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Although these two disorders are phenotypically unique, features present in these cases are variable, resulting in mixed and dominant expressions of particular features. We present the first adolescent case of trisomy 21 associated DS and fibrillin-1 gene associated MFS in the literature who had a height at 90th percentile for an 11-year old boy and discuss the implications of this case in terms of future medical care when these two genetic syndromes are present in the same individual. Understanding of certain features of the \u2018non-dominating\u2019 syndrome is crucial for clinicians to recognise when DS co-occurs with MFS. Close monitoring of the cardiovascular, ophthalmologic and musculoskeletal systems is recommended if both syndromes are diagnosed given that both can be independently associated with disorders in these organ systems.<\/jats:p>","DOI":"10.1136\/bcr-2020-235988","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T17:10:36Z","timestamp":1600881036000},"page":"e235988","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Down syndrome with co-occurring Marfan syndrome"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4499-5551","authenticated-orcid":false,"given":"Miao","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA"},{"name":"Radiology, Children's Hospital of Los Angeles, Los Angeles, California, 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