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Tenofovir-induced osteomalacia with hypophosphataemia
  1. Iulia Iatan1,
  2. Todd C Lee2 and
  3. Emily G McDonald1,2
  1. 1General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Emily G McDonald; emily.mcdonald{at}mcgill.ca

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.

  • renal system
  • calcium and bone
  • hepatitis B
  • unwanted effects / adverse reactions
  • fibromyalgia

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Footnotes

  • Contributors II: acquired and interpreted the patient’s clinical data, generated the final figures, drafted and reviewed the entire manuscript along with TCL and EGM; critically revised and approved the final article submitted; is accountable for all accuracy and integrity of the work TCL: interpreted the patient’s clinical data, drafted and revised the manuscript critically; reviewed and approved the final article submitted; is accountable for all accuracy and integrity of the work EGM: interpreted the patient’s clinical data, designed, drafted and revised the entire manuscript critically; reviewed and approved the final article submitted; directed and supervised the completion of the work; is accountable for all accuracy and integrity of the work All authors involved in the paper have participated in its preparation, drafting and revision, and have approved the entire contents of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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