Recalcitrant Low Back Pain Diagnosed as Hypophosphatemic Osteomalacia Induced by Antiviral Medication
10.35827/cp.2021.20.2.131
- Author:
Hyun Jun CHAE
1
;
Jun Hee WON
;
Won Kyung LEE
;
Keewon KIM
Author Information
1. Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Publication Type:Case Report
- From:
Clinical Pain
2021;20(2):131-134
- CountryRepublic of Korea
- Language:Korean
-
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.
