Simultaneous Transient Hyperphosphatasemia in a Set of Twins

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