HPP was first described by Canadian physician John C. Rathbun in an infant who presented with rickets and seizures at 2 months of age with low ALP, which was discovered later in autopsy.6 The highest prevalence of HPP is reported among Mennonites in Manitoba, Canada, with 1 in 25 individuals as carriers of the mutation and 1 in 2500 neonates having life-threatening HPP.7 More than 300 mutations have been described in TNSALP gene that can be transmitted autosomal recessive (severe form) or dominant resulting in HPP (mild form).3 Here, ALPL is linked to rickets.