title: [A case of severe hypophosphatemia related to adefovir dipivoxil treatment in a patient with liver cirrhosis related to hepatitis B virus].
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. hjlee@med.yu.ac.kr
authors.forename: Heon Ju
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Choi
authors.forename: Tae Nyeun
authors.initials: TN
authors.lastname: Kim
authors.forename: Jong Ryul
authors.initials: JR
authors.lastname: Eun
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil