Korean J Hepatol.  2008 Sep;14(3):381-386. 10.3350/kjhep.2008.14.3.381.

A case of severe hypophosphatemia related to adefovir dipivoxil treatment in a patient with liver cirrhosis related to hepatitis B virus

• Lee HJ
• Choi JW
• Kim TN
• Eun JR

• KMID: 1381468
• DOI: http://doi.org/10.3350/kjhep.2008.14.3.381

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.

Keyword

Adefovir; Hypophosphatemia; Osteomalacia

MeSH Terms

Absorptiometry, Photon
Adenine/administration & dosage/adverse effects/*analogs & derivatives
Adult
Antiviral Agents/administration & dosage/*adverse effects
Bone Density
DNA, Viral/analysis
Drug Resistance, Viral
Hepatitis B virus/drug effects
Hepatitis B, Chronic/complications/*drug therapy/virology
Humans
Hypophosphatemia/*chemically induced
Lamivudine/therapeutic use
Liver Cirrhosis/*virology
Male
Phosphonic Acids/administration & dosage/*adverse effects
Tomography, X-Ray Computed