Abstract
<h3>To the Editor.—</h3> I read with interest the recent article entitled "Transient, Marked, Unexplained Elevation of Serum Alkaline Phosphatase."<sup>1</sup>I would like to relate a case history of this condition that resulted in extensive evaluation, and I would also like to add information from the literature regarding this entity that was not discussed in the article. <h3>Report of a Case.—</h3> An 18-month-old female infant was referred to our institution for evaluation of lethargy, mild diarrhea, and an increased alkaline phosphatase level (5,200 units/L). Physical examination findings were unremarkable, but it was suspected that the patient had metastatic disease of the bone. Urinary vanillylmandelic acid and metanephrine levels were elevated, but extensive evaluation, including computed tomographic scan and bone marrow biopsy, failed to reveal any disease. Further examination of the alkaline phosphatase isoenzyme on gel electrophoresis showed an increase in the bone band and an abnormally migrating band just to
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