Sukhupanyarak P, Phatarakijnirund V. Transient hyperphosphatasemia in a toddler with COVID-19 infection: A case report and literature review. World J Clin Pediatr 2023; 12(4): 237-243 [PMID: 37753491 DOI: 10.5409/wjcp.v12.i4.237]
Corresponding Author of This Article
Voraluck Phatarakijnirund, MD, Assistant Professor, Division of Endocrinology, Department of Pediatrics, Phramongkutklao College of Medicine, No. 315 Ratchawithi Road, Phayathai, Ratchathewi, Bangkok 10400, Thailand. phatara.voraluck@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
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World J Clin Pediatr. Sep 9, 2023; 12(4): 237-243 Published online Sep 9, 2023. doi: 10.5409/wjcp.v12.i4.237
Transient hyperphosphatasemia in a toddler with COVID-19 infection: A case report and literature review
Pemiga Sukhupanyarak, Voraluck Phatarakijnirund
Pemiga Sukhupanyarak, Voraluck Phatarakijnirund, Division of Endocrinology, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Pemiga Sukhupanyarak, Division of Endocrinology, Department of Pediatrics, Buddhachinaraj Hospital, Phitsanulok 6500, Thailand
Author contributions: Sukhupanyarak P and Phatarakijnirund V contributed to manuscript writing and editing, data collection and final approval of the version of the article to be published
Informed consent statement: Subjects and legally authorized representative gave their written and verbal informed consent prior to study inclusion.
Conflict-of-interest statement: All authors state that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Voraluck Phatarakijnirund, MD, Assistant Professor, Division of Endocrinology, Department of Pediatrics, Phramongkutklao College of Medicine, No. 315 Ratchawithi Road, Phayathai, Ratchathewi, Bangkok 10400, Thailand. phatara.voraluck@gmail.com
Received: March 6, 2023 Peer-review started: March 6, 2023 First decision: May 9, 2023 Revised: May 25, 2023 Accepted: June 9, 2023 Article in press: June 9, 2023 Published online: September 9, 2023 Processing time: 183 Days and 4.6 Hours
Abstract
BACKGROUND
Transient hyperphosphatasemia (TH) is a condition characterized by elevated serum alkaline phosphatase (ALP) in the clinical setting with no evidence of bone or liver disease among children under the age of 5. Typically, it will resolve spontaneously in a few months in the majority of cases. TH has been found to be associated with viral infections. Two cases of TH associated with coronavirus disease 2019 (COVID-19) infection in toddlers have been previously reported.
CASE SUMMARY
A previously healthy 2-year-old boy presented with fever and positive real-time polymerase chain reaction for COVID-19. Prior to his illness, the patient had been in close contact with his grandfather, who later developed COVID-19. The physical examination on admission was unremarkable. He remained asymptomatic throughout 7 d of hospitalization. On the 5th day of his illness, blood tests showed markedly elevated serum ALP (4178 U/L). Results from the simultaneous testing of the remaining liver profiles and metabolic bone panels were normal. Two months after discharge from the hospital, the patient continued to thrive well. The skeletal surveys revealed no significant abnormalities. The serum ALP declined into the normal range adjusted for his age. This evidence is consistent with the diagnosis of TH.
CONCLUSION
TH can occur in COVID-19-infected toddlers. Serial measurements of ALP levels have been shown to gradually decline into the normal range within a few months. Therefore, being aware of this transient abnormality will help clinicians to avoid additional unnecessary investigations.
Core Tip: Transient hyperphosphatasemia (TH) is an unrecognized condition among children under the age of 5. The only abnormality demonstrated is markedly elevated serum alkaline phosphatase (ALP) without evidence of bone or hepatic disease and spontaneous resolution occurring in several months. Numerous reports have identified various viral infections as contributing factors to the etiology of this condition. TH should be considered in coronavirus disease 2019 -infected toddlers exhibiting isolated high serum ALP. Awareness of this condition will help to avoid unnecessary investigations.
