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• W4210942092 abstract "The patient, a 62-year-old wheelchair-bound male who had been taking antiretroviral therapy for 12 years, presented with lower limb proximal muscle weakness and bony pains for 1.5 years. An examination revealed an inability to bear weight on the left lower limb and muscle weakness. Prior evaluation for myopathy was unremarkable, with normal muscle enzymes and muscle biopsy. Thyroid profile and blood sugar were normal. Investigations revealed low phosphate level, raised alkaline phosphatase level, and normal calcium, 25(OH) vitamin D, and parathormone levels. Serum potassium was low with a transtubular potassium gradient of 31; urine examination showed proteinuria and glycosuria, and serum creatinine was raised. Arterial blood gas analysis revealed pH 7.36 with normal bicarbonate and pCO2. Plain radiographs of pelvis and knees showed insufficiency fractures involving the left ilium and bilateral fibula (Figure 1A and B). 99m Tc-methylene diphosphonate bone scintigraphy revealed multiple areas of increased tracer uptake involving long bones of bilateral lower limbs, multiple rib fractures, and insufficiency fractures in bilateral proximal fibulas and the left femur, suggestive of metabolic bone disease (Figure 1C). Insufficiency fractures—also called Looser’s zones—are characterized radiologically by wide, transverse lucencies with sclerotic margins perpendicular to the involved cortex, often partially traversing through the bone. Bilateral symmetrical involvement of the axillary border of the scapulae, posterior ulnae, or ribs usually favors a diagnosis of osteomalacia. Besides, the superior and inferior pubic rami and the proximal medial aspects of femora are also involved. A diagnosis of tenofovir-induced proximal tubular acidosis with osteomalacia was entertained, and tenofovir was stopped. Tenofovir nephrotoxicity includes proximal renal tubular acidosis with or without renal injury (1). Fanconi syndrome is characterized by proteinuria, glycosuria, acidosis, and hypophosphatemia manifesting as osteomalacia, consequent to proximal renal tubular dysfunction. A timely withdrawal of the inciting drug results in reversal of osteomalacia. Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
• W4210942092 created "2022-02-09" @default.
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• W4210942092 date "2022-02-07" @default.
• W4210942092 modified "2023-10-01" @default.
• W4210942092 title "Clinical Images: <scp>Tenofovir‐Induced</scp> Fanconi Syndrome: An Uncommon Cause of Hypophosphatemic Osteomalacia" @default.
• W4210942092 cites W2030888755 @default.
• W4210942092 doi "https://doi.org/10.1002/acr2.11415" @default.
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