An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.
Abstract
The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.
참고문헌 (14)
- Koenig KF, "Recurrent bone fractures due to tenofovir-induced renal phosphate wasting", Scand J Infect Dis, 46, pp.221~224 (2014)[DOI]
- Tanaka M, "Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report", Diagn Pathol, 7, pp.108~ (2012)[DOI]
- 정영걸, "Fanconi’s Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient", Gut and Liver, 4(3), pp.389~393 (2010), 거트앤리버 소화기연관학회협의회
- Kim du H, "Hypophosphatemic osteomalacia induced by low-dose adefovir therapy: focus on manifestations in the skeletal system and literature review", J Bone Miner Metab, 31, pp.240~246 (2013)[DOI]
- Terasaka T, "Long-term observation of osteomalacia caused by adefovir-induced Fanconi's syndrome", Acta Med Okayama, 68, pp.53~56 (2014)
- 정혜진, "Two Cases of Hypophosphatemic Osteomalacia After Long-term Low Dose Adefovir Therapy in Chronic Hepatitis B and Literature Review", 대한골대사학회지, 21(1), pp.76~83 (2014), 대한골대사학회
- Sit YK, "Corrective osteotomy in femoral non-union in drug-induced hypophosphataemic osteomalacia", BMJ Case Rep, 2014, pp.bcr2013201269~ (2014)[DOI]
- Tanji N, "Adefovir nephrotoxicity: possible role of mitochondrial DNA depletion", Hum Pathol, 32, pp.734~740 (2001)[DOI]
- Reginato AJ, "Musculoskeletal manifestations of osteomalacia and rickets", Best Pract Res Clin Rheumatol, 17, pp.1063~1080 (2003)[DOI]
- Garden RS, "Stability and union in subcapital fractures of the femur", J Bone Joint Surg Br, 46, pp.630~647 (1964)
- Le May M, "A factor determining the location of pseudofractures in osteomalacia", J Clin Invest, 28, pp.521~525 (1949)[DOI]
- Steinbach HL, "A mechanism of the production of pseudofractures in osteomalacia (Milkman's syndrome)", Radiology, 62, pp.388~395 (1954)[DOI]
- Lee C, "Pseudofracture of the neck of femur secondary to osteomalacia", J Bone Joint Surg Br, 89, pp.956~958 (2007)
- Palermo A, "Severe hypophosphatemic osteomalacia secondary to Fanconi syndrome due to adefovir: a case report", Endocr Pract, 20, pp.e246~e249 (2014)