Tenofovir-induced osteomalacia with hypophosphataemia

BMJ Case Rep. 2021 May 24;14(5):e240387. doi: 10.1136/bcr-2020-240387.

Abstract

Tenofovir disoproxil fumarate (TDF) is an antiretroviral drug widely used as a first-line treatment of hepatitis B virus (HBV) and HIV. Increasing evidence has emerged associating its use with the development of Fanconi syndrome, renal insufficiency and bone disease. We report a case of a 61-year-old woman with a remote history of liver transplant for cirrhosis due to HBV. Over 1 year, the patient had recurrent falls, generalised myalgias and arthralgias, misdiagnosed as fibromyalgia. We discuss a complication of her transplant treatment regimen with the drug TDF leading to a rare but reversible disorder: tenofovir-induced Fanconi osteomalacia with renal phosphate wasting. Though recognised, this rare disorder was initially likely missed due to clinical unfamiliarity with the diagnosis, concomitant psychiatric symptoms and premature diagnostic closure.

Keywords: calcium and bone; fibromyalgia; hepatitis B; renal system; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / therapeutic use
  • Fanconi Syndrome* / chemically induced
  • Fanconi Syndrome* / diagnosis
  • Fanconi Syndrome* / drug therapy
  • Female
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • Hepatitis B virus
  • Hepatitis B, Chronic* / drug therapy
  • Humans
  • Hypophosphatemia* / chemically induced
  • Hypophosphatemia* / diagnosis
  • Hypophosphatemia* / drug therapy
  • Middle Aged
  • Osteomalacia* / chemically induced
  • Osteomalacia* / diagnosis
  • Osteomalacia* / drug therapy
  • Tenofovir / adverse effects

Substances

  • Antiviral Agents
  • Tenofovir