RT Journal Article SR Electronic T1 Early diagnosis of Malan syndrome in an infant presenting with macrocephaly JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e249391 DO 10.1136/bcr-2022-249391 VO 15 IS 11 A1 Seed, Lydia A1 G, Natasha A1 Prentice, Sarah A1 Chandershekar, Prathiba YR 2022 UL http://casereports.bmj.com/content/15/11/e249391.abstract AB We present an infant with persistent macrocephaly and developmental delay. There is a wide range of differential diagnoses for this presentation, including many rare genetic conditions. Here, a diagnosis of Malan syndrome was made—a rare overgrowth syndrome caused by haploinsufficiency of NFIX and features affecting the neurological and musculoskeletal systems. Improvements in genomic medicine technologies and clinical services have revolutionised the way clinicians diagnose rare diseases. We highlight the importance of early genetic testing, particularly if there are red flag features such as developmental delay, and the need for a coordinated strategy to improve the management of rare diseases like Malan syndrome.