Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
권호 표지
DOI QR코드

DOI QR Code

Recalcitrant Low Back Pain Diagnosed as Hypophosphatemic Osteomalacia Induced by Antiviral Medication

항바이러스제에 의한 저인산성 골연화증으로 진단된 난치성 요통

  • Chae, Hyun Jun (Department of Rehabilitation Medicine, Seoul National University Hospital) ;
  • Won, Jun Hee (Department of Rehabilitation Medicine, Seoul National University Hospital) ;
  • Lee, Won Kyung (Department of Rehabilitation Medicine, Seoul National University Hospital) ;
  • Kim, Keewon (Department of Rehabilitation Medicine, Seoul National University Hospital)
  • 채현준 (서울대학교병원 재활의학과) ;
  • 원준희 (서울대학교병원 재활의학과) ;
  • 이원경 (서울대학교병원 재활의학과) ;
  • 김기원 (서울대학교병원 재활의학과)
  • Received : 2021.07.26
  • Accepted : 2021.09.03
  • Published : 2021.12.31
⟨ Previous Next ⟩

Abstract

We report a rare case of anti-viral agent induced hypophosphatemic osteomalacia presented with localized and radicular pain. A 51-year-old man, who had been taking adefovir for chronic hepatitis, had experienced low back pain radiating to his right thigh for 2 years. With impression of lumbar disc herniation, he underwent magnetic resonance imaging and found multi-level disc herniation with facet joint synovial cysts. He received transforaminal epidural steroid injections, however, symptoms did not improve. To find other possible causes, additional tests were performed. Blood tests revealed hypophosphatemia and increased serum alkaline phosphatase, and osteoporosis was noted in dual-energy X-ray absorptiometry with multiple hot uptakes in bone scan. After replacement of adefovir to entecavir and supplement of phosphate and vitamin D, phosphate level and the clinical symptoms were improved. This is the first to report the presentation of osteomalacia due to anti-viral agent as radicular low back pain with facet synovial cysts.

Keywords

References

  1. Bhan A, Rao AD, Rao DS. Osteomalacia as a result of vitamin D deficiency. Endocrinol Metab Clin North Am 2010;39:321-31. https://doi.org/10.1016/j.ecl.2010.02.001
  2. Fabbriciani G, de Socio GV, Massarotti M, Ceriani R, Marasini B. Adefovir induced hypophosphatemic osteomalacia. Scand J Infect Dis 2011;43:990-2. https://doi.org/10.3109/00365548.2011.581307
  3. Izzedine H, Hulot JS, Launay-Vacher V, Marcellini P, Hadziyannis SJ, Currie G, et al. Renal safety of adefovir dipivoxil in patients with chronic hepatitis B: two double-blind, randomized, placebo-controlled studies. Kidney Int 2004;66:1153-8. https://doi.org/10.1111/j.1523-1755.2004.00866.x
  4. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81. https://doi.org/10.1056/NEJMra070553
  5. Margulies JY PA, Nyska M, Neuwirth MG, Floman Y, Robin GC. The relationship between degenerative changes and osteoporosis in the lumbar spine. Clin Orthop Relat Res 1996;324:145-52. https://doi.org/10.1097/00003086-199603000-00017
  6. Csepregi A, Rojkovich B, Nemesanszky E, Poor G, Hejjas M, Horanyi M. Chronic seropositive polyarthritis associated with hepatitis B virus-induced chronic liver disease: a sequel of virus persistence. Arthritis Rheum 2000;43:232-3. https://doi.org/10.1002/1529-0131(200001)43:1<232::AID-ANR28>3.0.CO;2-O
  7. Kemmer NM, Sherman KE. Hepatitis C-related arthropathy: Diagnostic and treatment considerations. J Musculoskelet Med 2010;27:351-4.