[A case of severe hypophosphatemia related to adefovir dipivoxil treatment in a patient with liver cirrhosis related to hepatitis B virus].
Adefovir dipivoxyl (ADV) effectively suppresses hepatitis B virus (HBV) replication but exhibits nephrotoxicity with severe hypophosphatemia when administered at a high dosage. This is the first report of severe hypophosphatemic osteomalacia induced by ADV at 10 mg/day. A 42-year-old man with HBV-related chronic liver disease presented with generalized bone pain, especially in the left ankle. He had been taking ADV for more than 1.5 years following a clinical breakthrough due to lamivudine-resistant HBV. Aggravating severe hypophosphatemia and elevated serum alkaline phosphatase levels with high bone fraction had been noted after 6 months of ADV therapy. Bone densitometry, simple bone X-rays, and a whole-body bone scan demonstrated osteoporosis and multiple areas with hot uptake, especially in the left ankle. All the image findings and symptoms improved after correcting the hypophosphatemia.
Lee
Heon Ju
HJ
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. hjlee@med.yu.ac.kr
Choi
Jae Won
JW
Kim
Tae Nyeun
TN
Eun
Jong Ryul
JR
D015502:Absorptiometry, Photon; D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density; D004279:DNA, Viral / Q000032:analysis; D024882:Drug Resistance, Viral; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D017674:Hypophosphatemia / Q000139:chemically induced*; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000821:virology*; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil