Reactions 1455 - 8 Jun 2013

SAdefovir dipivoxil

Fanconi syndrome: case reportA 22-year-old man with chronic hepatitis B developed

Fanconi syndrome while receiving adefovir dipivoxil.The man was hospitalised in October with lumbar and left

knee pain, accompanied by numbness and discomfort in thesoles of both feet. MRI revealed bilateral changes in his hips, alumber vertebra out of place, lumbar spinal stenosis, changesin his right acetabulum, and synovitis in his right hip. He hadinitially been treated with methotrexate and/or sulfasalazineand NSAIDs for presumed ankylosing spondylitis orspondyloarthropathy, but the treatment had been ineffective.In May, he had developed worsening muscular weakness inboth lower limbs, and had been unable to walk withoutassistance. His upper limb strength had decreased, and he hadlost weight. He had been diagnosed with hepatitis B in 2007,and had taken adefovir dipivoxil over the four years since then[route and dosage not stated; duration of treatment to reactiononset not clearly stated]. At hospitalisation, examination foundmuscle atrophy in all four limbs, and the finger-floor distancein Schober’s test could not be tested without causingdiscomfort. X-ray revealed osteoporosis in the joints of bothlegs and both knees, and electromyography revealedmyogenic damage. Blood gas analysis revealed metabolicacidosis. Renal biopsy revealed pathological changes in hisproximal tubules and partial proximal tubule brush-bordermembrane loss, diagnosed as Fanconi syndrome.

Adefovir dipivoxil was switched to entecavir, and the manreceived hepatitis B vaccination, phosphate supplementation,and potassium citrate. Once his condition had stabilised, hewas discharged.

Author comment: Our patient was diagnosed withimpaired kidney function and acquired Fanconi syndrome . . .Our patient was taking the standard dosage of adefovirdipivoxil, and had suffered no basic kidney damage, but,having taken the medicine for four years it is possible that itwas related to the secondary illness.Li L, et al. Adefovir dipivoxil-induced Fanconi syndrome and hypophosphatemicosteomalacia associated with muscular weakness in a patient with chronic hepatitisB. Nan Fang Yi Ke Da Xue Xue Bao 31: 1956-1957, No. 11, Nov 2011 [Chinese;summarised from a translation] - China 803087489

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Reactions 8 Jun 2013 No. 14550114-9954/10/1455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved