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Hypophosphatemic osteomalacia and renal Fanconi syndrome induced by low‐dose adefovir dipivoxil: a case report and literature review suggesting ethnic predisposition
Author(s) -
Wu C.,
Zhang H.,
Qian Y.,
Wang L.,
Gu X.,
Dai Z.
Publication year - 2013
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12050
Subject(s) - osteomalacia , medicine , fanconi syndrome , hypophosphatemia , discontinuation , adefovir , gastroenterology , cirrhosis , pediatrics , vitamin d and neurology , kidney , immunology , chronic hepatitis , virus , lamivudine
Summary What is known and Objective Adefovir dipivoxil (ADV) is one of the commonly used antiviral agents in the treatment of chronic hepatitis B (CHB) infection. Safety of a daily dose of 10 mg ADV is advocated by the registration trials. We report a case of severe hypophosphatemic osteomalacia and renal Fanconi syndrome induced by low‐dose ADV in a CHB‐related cirrhosis patient, and discuss the case through a thorough review of other cases reported in the literature. Case summary A 48‐yr‐old Chinese man with CHB‐related cirrhosis developed severe progressive generalized bone pain and muscle weakness after receiving ADV 10 mg daily for 54 months. The laboratory results showed severe hypophosphatemia and features of proximal renal tubule dysfunction. Imaging studies were consistent with osteomalacia. After discontinuation of ADV, his symptoms resolved, laboratory abnormalities normalized and imaging studies showed improvement. In addition to our case, 12 other patients have been reported to have developed hypophosphatemic osteomalacia induced by low‐dose ADV. Most of the reported cases were of subjects of East‐Asian ethnicity. After discontinuation or reduction of ADV, serum phosphate level increased and clinical symptoms significantly improved in all cases. What is new and Conclusion Hypophosphatemic osteomalacia and renal Fanconi syndrome can be associated with low‐dose ADV. Clinicians treating CHB patients with ADV 10 mg daily over long periods of time should be aware of this infrequent but serious complication