Adefovir dipivoxil
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Reactions 1455 - 8 Jun 2013 S Adefovir dipivoxil Fanconi syndrome: case report A 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 the soles of both feet. MRI revealed bilateral changes in his hips, a lumber vertebra out of place, lumbar spinal stenosis, changes in his right acetabulum, and synovitis in his right hip. He had initially been treated with methotrexate and/or sulfasalazine and NSAIDs for presumed ankylosing spondylitis or spondyloarthropathy, but the treatment had been ineffective. In May, he had developed worsening muscular weakness in both lower limbs, and had been unable to walk without assistance. His upper limb strength had decreased, and he had lost 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 reaction onset not clearly stated]. At hospitalisation, examination found muscle atrophy in all four limbs, and the finger-floor distance in Schober’s test could not be tested without causing discomfort. X-ray revealed osteoporosis in the joints of both legs and both knees, and electromyography revealed myogenic damage. Blood gas analysis revealed metabolic acidosis. Renal biopsy revealed pathological changes in his proximal tubules and partial proximal tubule brush-border membrane loss, diagnosed as Fanconi syndrome. Adefovir dipivoxil was switched to entecavir, and the man received hepatitis B vaccination, phosphate supplementation, and potassium citrate. Once his condition had stabilised, he was discharged. Author comment: Our patient was diagnosed with impaired kidney function and acquired Fanconi syndrome . . . Our patient was taking the standard dosage of adefovir dipivoxil, and had suffered no basic kidney damage, but, having taken the medicine for four years it is possible that it was related to the secondary illness. Li L, et al. Adefovir dipivoxil-induced Fanconi syndrome and hypophosphatemic osteomalacia associated with muscular weakness in a patient with chronic hepatitis B. Nan Fang Yi Ke Da Xue Xue Bao 31: 1956-1957, No. 11, Nov 2011 [Chinese; summarised from a translation] - China 803087489 1 Reactions 8 Jun 2013 No. 1455 0114-9954/10/1455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Adefovir dipivoxil
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
