A case of intractable pain related to hypophosphatemic osteomalacia after adefovir dipivoxil therapy for hepatitis B

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  • UEMURA Yuhei
    Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University
  • HIRAKAWA Naomi
    Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University
  • SASAGURI Tomoko
    Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University
  • EGUCHI Yuichiro
    Department of Liver Disease Control and Assistance Task Force, Saga Medical School

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Other Title
  • 慢性B型肝炎治療薬adefovirにより生じた薬剤性骨軟化症による全身痛の1例
  • 症例 慢性B型肝炎治療薬adefovirにより生じた薬剤性骨軟化症による全身痛の1例
  • ショウレイ マンセイ Bガタ カンエン チリョウヤク adefovir ニ ヨリ ショウジタ ヤクザイセイコツ ナンカショウ ニ ヨル ゼンシンツウ ノ 1レイ

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Abstract

Adefovir dipivoxil is a commonly used antiviral agent for the treatment of chronic hepatitis B. Dose-related nephrotoxicity is reported and can definitely occur at daily dosages of >30 mg. We present a case of generalized intractable pain in a patient with chronic hepatitis B treated with adefovir dipivoxil for 5 years. A 42-year-old man complained of a 7-month history of generalized bone pain involving his knees, ankles, and low back. His severe pain was indicated by a visual analog scale value of 100 mm. Laboratory results showed renal tubular dysfunction, elevated serum alkaline phosphatase levels, and hypophosphatemia, and his calculated tubular phosphate reabsorption rate was reduced at only 5.2%. Radiologic examinations showed osteomalacia with multiple bone fractures. These results suggested a diagnosis of Fanconi's syndrome with osteomalacia. After discontinuation of adefovir dipivoxil, his symptoms improved, and his visual analog scale value recovered to 17 mm. Calculated tubular phosphate reabsorption rate recovered to 82.4% at 4 months after adefovir cessation.

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