Incapacitating pain from Tenofovir Induced Hypophosphatemic Osteomalacia in a Hemophilia Patient – A Case Report

Figures & data

Figure 1. (a) x-ray of right elbow showing significant joint degeneration. (b) MRI of the spine showing superior end plate compression fractures in T12 and L1 with minimal loss of height. (c) Bone scan revealing widespread increased uptake

Table 1. Etiologies of pain in patients with Hemophilia

Etiology	Location of Pain	Relevant papers
Hemophilic Arthropathy	Knee Hip Elbow Ankle Wrist	^Citation5, Citation17-19
Acute Hemarthrosis	Knee Hip Ankle Wrist
Hematoma	Psoas muscle Hip Lumbar Spine	^Citation20, Citation21
Synovitis	Knee Ankle Wrist	^Citation22, Citation23
Pseudotumor	Hip Lumbar Spine Wrist Abdomen Cranium	^Citation24, Citation25
Peripheral Nerve complications (Including HIV neuropathy)	Femoral Sciatic Peroneal Distal extremities	^Citation26
Osteoporotic fractures	Spine Wrist Hips Shoulder	^Citation6, Citation27

Valentino LA. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J Thromb Haemost. 2010;8(9):1895–902. doi:10.1111/j.1538-7836.2010.03962.x.

 PubMed Web of Science ®Google Scholar

Li J, Shen H, Hou T, Li M, He S, Zhang H. Acquired hemophilia a in a patient with lumbar disc herniation: A case report and review of the literature. Spine (Phila Pa 1976). 2009;34(8). doi:10.1097/BRS.0b013e31819740d6

 Web of Science ®Google Scholar

Kahraman S, Şirin S, Kayali H, Solmaz I, Bedük A. Low Back Pain Due to Spinal Chronic Subdural Hematoma Mimicking Intradural Tumor in the Lumbar Area: A Case Report and Literature Review. J Pain. 2003;4(8):471–5. doi:10.1067/S1526-5900(03)00732-6

 PubMed Web of Science ®Google Scholar

Manetti, Linari, Romano, et al. TNF-α/TNF-R System May Represent a Crucial Mediator of Proliferative Synovitis in Hemophilia A. J Clin Med. 2019;8(7):939. doi:10.3390/jcm8070939

 Google Scholar

Hanley J, McKernan A, Creagh MD, et al. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia: A United Kingdom Haemophilia Centre Doctors’ Organisation (UKHCDO) guideline. Haemophilia. 2017;23(4):511–520. doi:10.1111/hae.13201

 PubMed Web of Science ®Google Scholar

Ying SH, Chen WM, Wu PK, Chen CF, Liu CL, Chen TH. Pelvic hemophilic pseudotumor presenting as severe sciatic pain in a patient with no history of hemophilic symptoms. J Orthop Sci. 2012;17(4):490–494. doi:10.1007/s00776-011-0094-7

 Web of Science ®Google Scholar

Horton DD, Pollay M, Wilson DA, Brandon FM, Sexauer CL. Cranial hemophilic pseudotumor. Journal of Neurosurgery. 1993;79(6). https://doi-org.ezproxy.library.ubc.ca/10.3171/jns.1993.79.6.0936

 Web of Science ®Google Scholar

Saraf S, Singh O, Singh V. Peripheral Nerve Complications in Hemophilia. J Assoc Physicians India. 2003;51.

 Google Scholar

Young G. New challenges in hemophilia: long-term outcomes and complications. Hematology Am Soc Hematol Educ Program. 2012;2012(1):362–68. doi:10.1182/asheducation.v2012.1.362.3798344.

 Google Scholar

Rodriguez-Merchan EC, Valentino LA. Increased bone resorption in hemophilia. Blood Rev. 2019;33:6–10. doi:10.1016/j.blre.2018.05.002

 PubMed Web of Science ®Google Scholar