Despite XXYY syndrome initially being considered a variant of Klinefelter syndrome, now it is widely regarded as a separate clinical syndrome with psychological, morphological, and neurodevelopmental involvement [
9‐
11]. While it is a sex chromosome aneuploidy, studies of live births reported a relatively rare incidence of 1:18000–1:50000 [
3,
10]. Nonetheless, the case we present here is the first reported case in Syria and only two other cases have been reported in the region, in Turkey [
12]. It was reported that the most prominent symptom in patients with Klinefelter syndrome was tall stature [
13]. However, while tall stature was reported in 48,XXYY syndrome [
7], it also concluded that patients with 48,XXYY syndrome were mostly of short stature, which is in accordance with our patient, who was not tall [
2]. It was reported that patients with this syndrome suffered from infertility [
14] due to its association with hypergonadotropic hypogonadism [
3,
15] as well as its association with other endocrine manifestations such as acromegaloidism [
16]. In our study, this concurred with our clinical findings, and our patient’s presenting symptom of infertility, which were suggestive for our patient to undertake genetic testing. It was also reported that the skeletal deformities that were present in 48,XXYY syndrome were the typical clinodactyly of the fifth finger [
3], kyphoscoliosis of the spine [
8], and one case reported an increased thickness of the neck [
17]; but no other cases of 48,XXYY syndrome reported having an apparent abnormally wide neck characteristic of syndromes such as Noonan syndrome [
18], front slouched neck posture, and clinodactyly of the third finger. To the best of our knowledge, this is the first case to report these features as accompanying symptoms for 48,XXYY syndrome.