Fanconi syndrome induced by adefovir dipivoxil: a case report and clinical review

Abstract

More than 150 cases of Fanconi syndrome (FS) or hypophosphatemia osteomalacia induced by low-dose adefovir dipivoxil (ADV) have been reported since 2002, when ADV was introduced for the long-term treatment of hepatitis B virus (HBV) infection. Because the life expectancy of HBV-infected individuals has increased, the adverse effects of long-term treatment with antiviral therapies are increasingly observed, and nephrotoxicity is one of the most severe adverse effects of ADV. Therefore, the number of cases may be far higher than reported. Moreover, ADV-induced FS is often misdiagnosed or diagnosed long after it first develops. ADV-induced FS may seriously decrease patient quality of life and lead to bone fractures and even disability. Although progress has been made in the identification of biomarkers and treatments, few systematic clinical guidelines or clinical reviews for FS induced by ADV have been reported. In this study, we highlighted the recent progress toward understanding of FS induced by ADV, described a clinical case, and summarized the primary characteristics and laboratory findings of this disease.

Keywords: Fanconi syndrome; adefovir dipivoxil; adverse effects; antiviral therapy; hepatitis B virus; hypophosphatemia; nephrotoxicity; osteomalacia.

Figure 1.

Radiographic changes. Magnetic resonance imaging of the right knee suggested fractures of the right medial tibial plateau (a) and fibula head (b). Bone scintigraphy uncovered multiple foci of increased radiotracer uptake in multiple bones and possible osteomalacia (c).

Figure 2.

Radiographic changes after discharge. Magnetic resonance imaging of the (a) right medial tibial plateau and (b) fibula head. (c) Bone scintigraphy.