Department of 1Rehabilitation Medicine, Wonkwang University College of Medicine, Iksan, Korea.
NeuroRehabilitation. 2010;26(2):159-62. doi: 10.3233/NRE-2010-0548.
The new antivirals clevudine, telbivudine and emtricitabine may be potent agents for the treatment of hepatitis B virus (HBV). However, there have been no reports on serious adverse events associated with the use of clevudine. A son and his mother both had HBV infection (ages: 27 and 47 years, respectively), and they had received antivirus treatment with clevudine (30 mg daily). They developed progressive weakness of the lower extremities and difficulty arising from the ground. Both the patients had symptoms for the previous 3 approximately 4 months in process of 14 approximately 17 months of clevudine therapy. The physical examinations showed positive Gower's sign, a decreased gait velocity and symmetrical proximal weakness (MRC grade 4/5). Their blood tests at admission revealed elevated or positive HBs Ag, HBV DNA, AST, ALT, creatine kinase, LDH, myoglobin and CK-MB. For both patients, the electrodiagnostic studies indicated myopathy and the pathologic findings of biopsied muscles revealed myositis. Drug-induced polymyositis was suspected and the clevudine was finally withdrawn. The muscle weakness and laboratory findings were improved for both patients after conservative care. We report here on the first cases of polymyositis that may have been caused by administering the new nucleoside analog clevudine for treating HBV infection.
新型抗病毒药物拉米夫定、替比夫定和恩曲他滨可能是治疗乙型肝炎病毒（HBV）的有效药物。然而，目前尚无关于拉米夫定相关严重不良事件的报告。一名儿子和他的母亲均患有乙型肝炎病毒感染（年龄分别为 27 岁和 47 岁），并接受了拉米夫定（每日 30mg）抗病毒治疗。他们出现了下肢进行性无力和从地上起身困难的症状。在接受拉米夫定治疗的 14-17 个月过程中，两名患者均有大约 3-4 个月的前驱症状。体格检查显示阳性的 Gower 征、步态速度降低和对称性近端肌无力（MRC 分级 4/5）。他们入院时的血液检查显示 HBsAg、HBV DNA、AST、ALT、肌酸激酶、LDH、肌红蛋白和 CK-MB 升高或阳性。对两名患者进行的电诊断研究表明存在肌病，活检肌肉的病理发现显示肌炎。怀疑是药物引起的多发性肌炎，最终停用了拉米夫定。在接受保守治疗后，两名患者的肌肉无力和实验室检查结果均有所改善。我们在此报告了首例可能由新型核苷类似物拉米夫定治疗乙型肝炎病毒感染引起的多发性肌炎病例。
