Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China.
School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
BMC Pharmacol Toxicol. 2020 Jun 5;21(1):43. doi: 10.1186/s40360-020-00421-6.
Progressive bone pain and fracture and abnormal positron emission tomography combined with a computed tomography are main reasons for the oncologists suspecting bone tumor. During the patient's medical treatment, the oncologists' unfamiliarity with adverse reactions to anti-HBV drugs were main reason for the long-term exposure to the drug and the adverse reaction (ADR) experienced by the patient.
A 63-year-old Chinese man had a 27-month history of progressive generalized bone pain combined with spontaneous fractures. Positron emission tomography combined with a computed tomography, revealed an abnormal increase in ribose metabolism and low positron serum inorganic phosphorus concentration (0.7; 0.78-1.65 mmol/L). Serum creatinine level was 252 μmol/L (53-97) μmol/L, and glomerular filtration rate was 22.79 mL/min/1.73 m. The patient was referred to a multidisciplinary clinic to clarify the diagnosis of myeloma or bone tumor for further treatment in 2017. His medical history revealed that he had a 30-year history of chronic hepatitis B infection. He had received lamivudine at a daily dose of 100 mg for 19 years (1990 to 2009), which had been changed to adefovir (10 mg/day) owing to lamivudine resistance in 2009. Based on the changes in the patient's laboratory markers and the results of emission computed tomography and other radiographic findings, adefovir-induced hypophosphatemic osteomalacia due to acquired renal Fanconi syndrome was suspected by the clinical pharmacist. Considerable clinical improvement was observed after adefovir discontinuation and the administration of entecavir (1.0 mg, every other day).
Fanconi syndrome with osteomalacia can develop in patients with chronic hepatitis B infection being treated with adefovir at a conventional low dosage of 10 mg/day. This case highlights the importance of ADR as a differential diagnosis and the need of pharmacists with drug safety expertise expert in the patient management.
进行性骨痛和骨折以及正电子发射断层扫描与计算机断层扫描相结合是肿瘤学家怀疑骨肿瘤的主要原因。在患者的治疗过程中，肿瘤学家对乙肝抗病毒药物不良反应的不熟悉是导致患者长期暴露于该药物并发生不良反应（ADR）的主要原因。
一名 63 岁的中国男性，有 27 个月的进行性全身性骨痛伴自发性骨折病史。正电子发射断层扫描与计算机断层扫描显示肋骨代谢异常增加，正电子血清无机磷浓度降低（0.7；0.78-1.65mmol/L）。血清肌酐水平为 252μmol/L（53-97）μmol/L，肾小球滤过率为 22.79mL/min/1.73m。患者于 2017 年被转至多学科诊所，以明确多发性骨髓瘤或骨肿瘤的诊断，进而进行进一步治疗。患者病史显示，其患有乙型肝炎感染 30 年。1990 年至 2009 年，他每天服用 100mg 拉米夫定治疗，2009 年因拉米夫定耐药而改用阿德福韦（10mg/天）。基于患者实验室标志物的变化以及发射计算机断层扫描和其他影像学检查结果，临床药师怀疑该患者患有阿德福韦引起的获得性肾范可尼综合征继发低磷性骨软化症。阿德福韦停药和恩替卡韦（1.0mg，隔日一次）治疗后，患者病情明显改善。
在接受常规低剂量 10mg/天阿德福韦治疗的慢性乙型肝炎感染患者中，可发生范可尼综合征伴骨软化症。该病例强调了 ADR 作为鉴别诊断的重要性，以及需要具有药物安全专业知识的药师参与患者管理。
