Adefovir Dipivoxil-induced Fanconi's Syndrome and Osteomalacia Following Multiple Bone Fractures in a Patient with Chronic Hepatitis B

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  • Makita Takashi
    Department of Pharmacy, Okayama University Hospital
  • Kanzaki Hirotaka
    Department of Pharmacy, Okayama University Hospital
  • Onishi Hideki
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Ikeda Ailee
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Takaki Akinobu
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Wada Nozomu
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Takeuchi Yasuto
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Yasunaka Tetsuya
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Ikeda Fusao
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Shiraha Hidenori
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Tanaka Yuta
    Department of Pharmacy, Okayama University Hospital
  • Nishihara Shigeki
    Department of Pharmacy, Okayama University Hospital
  • Murakawa Kiminaka
    Department of Pharmacy, Okayama University Hospital
  • Kitamura Yoshihisa
    Department of Pharmacy, Okayama University Hospital
  • Okada Hiroyuki
    Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Sendo Toshiaki
    Department of Pharmacy, Okayama University Hospital

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Other Title
  • Case Report : Adefovir Dipivoxil-induced Fanconi's Syndrome and Osteomalacia Following Multiple Bone Fractures in a Patient with Chronic Hepatitis B

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Abstract

<p>We herein present the case of a 66-year-old Japanese man with Fanconi's syndrome. He had been receiving adefovir dipivoxil (ADV) for the treatment of entecavir (ETV)-resistant chronic hepatitis B (CHB) for four years in his 8-year treatment of hepatocellular carcinoma (HCC), but was referred to our hospital after increased levels of bone pain in his ribs, knees, and ankles. Renal dysfunction, hypophosphatemia, and increased levels of bone alkaline phosphatase were found by a hematology test after admission for treatment of HCC. Radiography and 99m Tc-labeled hydroxymethylene diphosphonate (HMDP) scintigraphy revealed multiple insufficiency fractures in the ribs, knees, ankles, and heels. After switching from ADV to tenofovir disoproxil fumarate (TDF) and treatment with calcitriol and sodium dihydrogenphosphate, the patient's serum phosphate levels slightly increased and renal dysfunction did not improve, but after six months his clinical symptoms disappeared. To detect and prevent adverse effects from ADV, physicians and pharmacists should carefully monitor renal function and serum phosphate levels in patients with hepatitis B virus (HBV) treated for a long time with ADV.</p>

Journal

  • YAKUGAKU ZASSHI

    YAKUGAKU ZASSHI 139 (4), 641-645, 2019-04-01

    The Pharmaceutical Society of Japan

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