저용량 adefovir dipivoxil에 의한 저인산염혈증과 다발성 근육통 1예
A case of hypophosphatemic osteomalacia associated with low-dose adefovir dipivoxil treatment
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초록
ADV는 고용량에서 신독성을 유발할 수 있으나 저용량에서는 매우 드물다. 류마티스 영역에서 다발성 근육통, 관절통을 호소하는 환자의 병력을 청취할 때 약물복용에 대한 자세한 문진도 중요하다는 사실을 인지하여야 하겠다. 저자들은 라미부딘 내성 만성 B형 간염 환자에서 10 mg의 ADV를 사용하던 중 저인산염혈증과 동반된 다발성 근육통이 발생하여, 혈액 검사 및 영상학적 검사 소견으로 골연화증으로 진단된 후 ADV 투여 중지 이후 자각증상과 검사 소견이 호전된 1예를 경험하였기에 임상적 의미에 대한 고찰과 함께 보고하는 바이다.
Abstract
Adefovir dipivoxil (ADV) effectively inhibits lamivudine-resistant hepatitis B virus replication. Hypophosphatemia and elevated serum creatinine are ADV-related nephrotoxicity caused by high-dose ADV. Hypophosphatemic osteomalacia is very rare and is induced by low-dose ADV. A 61-year-old man suffering from chronic hepatitis B manifested with generalized myalgia and bone pain, especially in both ankles and knees. He had been administered ADV for 56 months, since lamivudine-resistant HBV was detected. He developed severe hypophosphatemia and elevated serum alkaline phosphatase levels with a high bone fraction. Bone densitometry and a whole-body bone scan revealed osteoporosis and multiple hot uptake lesions. Blood chemistry and clinical symptoms improved after discontinuing the ADV.
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