Transient hyperphosphatasemia: Possible association with pediatric acute respiratory infection

Sakurai, Yoshihiko; Higashiguchi, Takafumi

doi:10.1002/ped4.12265

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…The electrophoretic evaluation of the ALP isoenzymes and isoforms in blood samples from patients with THI revealed an atypical transient pattern of cathodal and anodal migrating fractions, similar to the isoforms of bone and liver origin (4,5,8,13). THI is most probably caused by a viral infection as THI frequently occurs in children with a history of viral disease 2-3 weeks prior to the S-ALP elevation and was also observed and reported in siblings or in patients who were hospitalised together (5,(14)(15)(16). This also occurred in our patient, as febrile, most probably viral, infection preceded the detection of high S-ALP.…”

Section: Discussionmentioning

confidence: 76%

Transient Hyperphosphatasemia in a Child with Autism Spectrum Disorder

Kutı́lek

Rondziková-Mlynarčíková

Pečenková

et al. 2022

Acta Med. (Hradec Kralove, Czech Repub.)

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Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. Transient hyperphosphatasemia of infancy and early childhood (THI) is a benign laboratory disorder characterized by transiently extremely elevated activity of serum alkaline phosphatase (S-ALP). Case Report: We present a 21-month-old girl with a right leg limp, most probably due to reactive arthritis after febrile viral infection, and deterioration of psychomotor development with concomitant transient elevation of S-ALP (61.74 μkat/L; normal 2.36–7.68 μkat/L). Normal values of serum creatinine, aspartate-aminotransferase, alanin-aminotransferase, calcium, phosphate, together with normal wrist X-ray ruled out rickets or other bone or hepatic cause of high S-ALP. The S-ALP gradually decreased within 3 months, thus fulfilling the THI criteria. Screening for inborn errors of metabolism was negative and meticulous neurologic, psychologic and psychiatric assessment pointed to the diagnosis of autism spectrum disorder (ASD). There was no causal relationship between THI and ASD, as high S-ALP was an accidental and transient finding within the routine laboratory assessment. However, when THI occurs in a child with an onset of a new disorder, or with a pre-existing bone or liver disease, it might seriously concern the physician. Conclusion: Children with THI should be spared from extensive evaluations and unnecessary blood draws.

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Section: Discussionmentioning

confidence: 76%

Transient Hyperphosphatasemia in a Child with Autism Spectrum Disorder

Kutı́lek

Rondziková-Mlynarčíková

Pečenková

et al. 2022

Acta Med. (Hradec Kralove, Czech Repub.)

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“…Bone pathologies include bone disorders such as rickets, healing fractures, Paget’s disease, and bone tumors. Hepatic pathologies include extrahepatic biliary obstruction, intrahepatic cholestasis, malignancy, and hepatitis [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Hand, Foot, and Mouth Disease Associated With Transient Hyperphosphatasemia

Verma¹,

Keaton²,

McGuffin³

2022

Cureus

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A majority of pediatric outpatient practice involves managing familiar diseases that present in familiar ways. Occasionally, a familiar disease presents uniquely, which adds a diagnostic challenge and enhances the clinical experience of the clinician. We describe an 18-month-old male who presented to the clinic with a familiar disease but with unique additional findings. The patient had a one-day history of rash, subjective fever, and several episodes of non-bloody diarrhea. The rash included petechial lesions across his abdomen, groin, back, arms, and legs, as well as vesicular lesions in the mouth and on the palms and soles. A tentative diagnosis of hand, foot, and mouth disease (HFMD) was made. However, the presence of petechiae prompted further laboratory evaluation, including a complete blood count (CBC) and comprehensive metabolic panel (CMP). The CBC was unremarkable, but the CMP revealed an abnormally high serum alkaline phosphatase (ALP) level of 1,353 U/L (normal range: 53-128 U/L). The patient was subsequently diagnosed with an atypical presentation of HFMD associated with transient hyperphosphatasemia (TH). TH is characterized by a benign increase in serum alkaline phosphatase levels with an absence of liver or bone diseases. TH is usually clinically silent. Clinicians should consider the possibility of TH in pediatric patients who are found incidentally to have an elevated ALP, especially with a concomitant viral infection. An awareness and understanding of TH will prevent unnecessary additional testing and avoid undue parental anxiety.

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“…Among those conditions that may mimic rickets because of similar signs and symptoms, two pathological entities deserve a special mention: hypophosphatasia and transient hyperphosphatasemia ( 30 – 33 ). Hypophosphatasia is a condition characterized by a reduction of serum ALP levels ( 30 ).…”

Section: The Role Of Alp In Hypophosphatasia and Transient Hyperphosp...mentioning

confidence: 99%

“…TH is not yet clearly defined, as there is no agreement on the ALP cutoff values for its diagnosis, the age limits, and the possible causes. A possible association between TH and acute respiratory infections has been suggested ( 33 ). It is interesting to consider that the ALP levels are usually markedly elevated in TH, sometimes as high as 4000-7000 IU/L ( 30 ).…”

Section: The Role Of Alp In Hypophosphatasia and Transient Hyperphosp...mentioning

confidence: 99%

Alkaline phosphatase in clinical practice in childhood: Focus on rickets

et al. 2023

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Serum alkaline phosphatase (ALP) and its isoenzymes reflect bone metabolism: ALP increases the ratio of inorganic phosphate to pyrophosphate systemically and facilitates mineralization as well as reduces extracellular pyrophosphate concentration, an inhibitor of mineral formation. On the contrary, low ALP activity is associated with reduction of bone turnover. ALP includes four isoenzymes depending on the site of tissue expression: intestinal ALP, placental ALP, germ cell ALP and tissue nonspecific ALP or liver/bone/kidney ALP. The bone isoenzyme (B-ALP) is involved in bone calcification and is a marker of bone turnover as a result of osteoblastic activity. ALP and its isoenzymes are crucial in the diagnostic process of all the forms of rickets.The most common cause of rickets is vitamin D nutritional deficiency. The aim of this review is to update on the role played by ALP serum concentrations as a relevant marker in thediagnosis and treatment of rickets. Indeed, the diagnosis of rickets is based on its clinical, radiological and laboratory characteristics. An elevated ALP level is one of the markers for the diagnosis of rickets in children, though it is also associated with bone formation process. ALP is also useful for the differentiation between rickets and other disorders that can mimic rickets because of their clinical and laboratory characteristics, and, together with other biochemical markers, is crucial for the differential diagnosis of the different forms of rickets. Age, severity and duration of rickets may also modulate ALP elevation. Finally, ALP measurements are useful in clinical and therapeutic follow-up.

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Transient hyperphosphatasemia: Possible association with pediatric acute respiratory infection

Cited by 6 publications

References 14 publications

Transient Hyperphosphatasemia in a Child with Autism Spectrum Disorder

Transient Hyperphosphatasemia in a Child with Autism Spectrum Disorder

Hand, Foot, and Mouth Disease Associated With Transient Hyperphosphatasemia

Alkaline phosphatase in clinical practice in childhood: Focus on rickets

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