title: Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil.
abstract: We report the case of a patient treated with living donor-related liver transplantation who suffered from osteomalacia during adefovir dipivoxil (ADV)-containing antiviral therapy for lamivudine-resistant hepatitis B virus infection. The patient had generalized bone pain, with severe hypophosphatemia after 20 mo of ADV therapy. Radiographic studies demonstrated the presence of osteomalacia. The peak plasma ADV level was 38 ng/mL after administration of ADV at 10 mg/d. It was also found that ADV affected the metabolism of tacrolimus, a calcineurin-inhibitor, and caused an increase in the plasma levels of tacrolimus. The disability was reversed with the withdrawal of ADV and with mineral supplementation. ADV can cause an elevation of plasma tacrolimus levels, which may be associated with renal dysfunction. High levels of ADV and tacrolimus can cause nephrotoxicity and osteomalacia. This case highlights the importance of considering a diagnosis of osteomalacia in liver transplantation recipients treated with both ADV and tacrolimus.
authors.affiliation: Masami Minemura, Yoshiharu Tokimitsu, Kazuto Tajiri, Yasuhiro Nakayama, Kengo Kawai, Hiroshi Kudo, Katsuharu Hirano, Yoshinari Atarashi, Yutaka Yata, Satoshi Yasumura, Terumi Takahara, Toshiro Sugiyama, Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Minemura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tokimitsu
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tajiri
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Kengo
authors.initials: K
authors.lastname: Kawai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kudo
authors.forename: Katsuharu
authors.initials: K
authors.lastname: Hirano
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Atarashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasumura
authors.forename: Terumi
authors.initials: T
authors.lastname: Takahara
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugiyama