Case Report
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World J Gastroenterol. Sep 7, 2013; 19(33): 5575-5580
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5575
Lactic acidosis during telbivudine treatment for HBV: A case report and literature review
Jia-Lin Jin, Piao Hu, Jia-Hong Lu, Su-Shan Luo, Xiao-Yun Huang, Xin-Hua Weng, Ji-Ming Zhang
Jia-Lin Jin, Piao Hu, Xiao-Yun Huang, Xin-Hua Weng, Ji-Ming Zhang, Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
Piao Hu, Department of Infectious Diseases, Xiaoshan First People’s Hospital, Hangzhou 311200, Zhejiang Province, China
Jia-Hong Lu, Su-Shan Luo, Department of Internal Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
Author contributions: Jin JL diagnosed and treated the patient and wrote the manuscript; Hu P followed up the patient; Lu JH and Luo SS performed the muscle biopsy and provided the histopathologic pictures; Huang XY was involved in the preparation of the manuscript; Weng XH and Zhang JM helped diagnose and manage the patients and prepare the manuscript.
Supported by National Natural Science Foundation of China, No. 81071354 and 81271833; National “973’’ Project, No. 2012CB519001; National Science and Technology Major Project of China, No. 2012ZX10002007-001-002, No. 2013ZX10002001
Correspondence to: Ji-Ming Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhonglu, Jing'an District, Shanghai 200040, China. jmzhang@fudan.edu.cn
Telephone: +86-21-52888125 Fax: +86-21-62489015
Received: May 1, 2013
Revised: July 6, 2013
Accepted: July 30, 2013
Published online: September 7, 2013
Processing time: 131 Days and 22.8 Hours
Abstract

All oral nucleoside analogues against hepatitis B virus, with an exception of telbivudine, have been reported causing lactic acidosis (LA). Here we report the first case of chronic hepatitis B developing severe refractory LA during telbivudine monotherapy. A 36-year-old man of Chinese origin received telbivudine antiviral treatment for chronic hepatitis B. After 11 mo of therapy, he developed anorexia, nausea, and vomiting with mild muscle weakness. The patient was found with elevated serum creatine phosphokinase up to 3683 U/L (upper limit of normal 170 U/L) and marked LA. LA did not resolve immediately following discontinuation of telbivudine. His condition began to improve after hemodialysis treatment for 16 times and usage of glucocorticosteroid. The patient fully recovered after 16 wk of treatment. This is the first documented case with severe LA caused by telbivudine monotherapy. Besides serum creatine phosphokinase, blood lactate level should also be closely monitored in patients receiving telbivudine.

Keywords: Lactic acidosis/hyperlactatemia; Telbivudine; Hepatitis B virus; Nucleoside analogue; Adverse effects

Core tip: Myopathy is the most common side effect resulting from telbivudine. Lactic acidosis (LA) is rare but fatal, and LA caused by telbivudine has never been reported. Here, we report the first case of chronic hepatitis B developing severe refractory LA during telbivudine monotherapy. This case shows that telbivudine may cause muscle damage and even lead to fatal LA in chronic hepatitis B patients. Patients under telbivudine treatment should be closely monitored for muscular, blood lactate and other mitochondrial toxicity associated side effects.