A one-year-old girl with coarse facial characteristics, skeletal malformation, and abdominal distension was born to third-degree consanguineous parents. Upon examination, the peripheral smear demonstrated Alder-Reilly anomaly seen in neutrophils and occasional lymphocytes and monocytes , indicating mucopolysaccharidosis (MPS). The cytoplasmic inclusions are composed of acid mucopolysaccharides, which are indigestible in patients with mucopolysaccharidoses.   A diagnosis of MPS type VI (Maroteaux-lamy syndrome) was suggested by the results of molecular testing. Aryl-sulfatase B enzyme deficiency was verified by enzyme tests. In order to demonstrate the connection between MPS and the Alder-Reilly anomaly in Maroteaux-Lamy syndrome, we describe this uncommon example. (Panels A-E; Wright-Giemsa stain, objective magnification 100x, total magnification 1000x).