Entecavir/tenofovir disoproxil fumarate
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Various toxicities and first report for tooth loss: case report An approximately 39-year-old-man exhibited a lack of efficacy following treatment with entecavir for Hepatitis B virus infection. Additionally, he developed halitosis, gingival swelling, gingival pain and tooth loss during treatment with tenofovir disoproxil fumarate. In 2008, the man was diagnosed with Hepatitis B virus infection. His history was non-significant for autoimmune hepatitis, HIV and hepatitis A. Furthermore, he had no history of alcoholism or smoking. He received oral entecavir 0.5mg QD for 9 years. In March 2017, lab reports showed he had HBV YMDD gene mutation and median liver stiffness. Entecavir treatment resistance was suspected, and it was replaced with oral tenofovir disoproxil fumarate 300mg, every day [Viread]. In March 2018, he underwent transcatheter splenic arterial embolisation for low platelet count and hypersplenism. Along with this, he also received spironolactone, tramadol, glutathione, faropenem, Xinhuang tablet, and anethol trithione for 1 month. His blood glucose level gradually increased, but he didn’t receive any antidiabetics. In March 2019, he visited hospital with a 22 months history of halitosis and 11 months history of tooth loss along with, gingival swelling and pain. Investigation revealed, his oral malodour started after 2 months of tenofovir disoproxil fumarate initiation, followed by gingival swelling and pain were observed after 11 months. Then, he started losing his teeth. Dental atrophy was considered and he received symptomatic filling; however, it was ineffective. Upon a visit to the clinic of hepatitis, his laboratory tests showed the following: total bilirubin 23.7 µmol/L, prealbumin 170 mg/L, creatinine 78 µmol/L, inorganic phosphorus 1.07 mmol/L and alpha-fetoprotein
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