Sir.—The diagnostic features of benign transient hyperphosphatasemia are (1) patient age of less than 5 years; (2) variable, usually unrelated symptoms; (3) no physical evidence for bone or liver disease; (4) no other biochemical or laboratory evidence for bone or liver disease (including normal isoenzymes, if test is done); and (5) a return to normal serum alkaline phosphatase level within 4 months with no sequelae.1 The cause is unknown but proposed mechanisms include malnutrition, drug induction, viral infection, and transient impeded clearance of serum alkaline phosphatase.1 The two patients described herein are, to our knowledge, the first set of twins who developed the syndrome simultaneously.
Patients and Methods.—These 11-month-old white male twins were well until an age of 9 months, when they developed severe diarrhea. Stool cultures from both were positive for Salmonella. No antibiotics were given. They continued to have frequent loose stools over the
KRAUT JR, SHAH B. Simultaneous Transient Hyperphosphatasemia in a Set of Twins. Am J Dis Child. 1989;143(8):881–882. doi:10.1001/archpedi.1989.02150200017008