Abstract: SA-PO1137
Fanconi Syndrome from Adenovirus Treatment in a Renal Transplant Patient: A Rare Complication from Novel Therapy with Brincidofovir
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Varela, Daniel, University of Texas Rio Grande Valley, El Paso, Texas, United States
- Tasnif, Yasar, DHR Health Transplant Institute, McAllen, Texas, United States
- Alsabbagh, Mourad, Doctors Hospital at Renaissance, Edinburg, Texas, United States
Introduction
Brincidofovir is an oral pro-drug of cidofovir currently in Phase III clinical trials. In comparison to cidofovir, it displays lower nephrotoxic potential. We present a case of Fanconi syndrome within a week of therapy of brincidofovir for a patient with Adenovirus infection. This rare side effect has not been reported in the literature.
Case Description
We present a 62 year old woman with chronic kidney disease due to diabetes mellitus-2 and hypertension, who received a deceased donor kidney transplant. Induction therapy included alemtuzumab, solumedrol, and mycophenolate mofetil. Her baseline serum creatinine post-transplant was 0.7. Two months later her renal function began to worsen. A renal biopsy was performed which showed no evidence of acute cellular or antibody mediated rejection. However, BK virus as well as Adenovirus was found in both blood and urine. Immunosuppression medications were minimized; IVIG therapy for severe BK viremia and brincidofovir for Adenovirus viremia was initiated due to worsening viremia (656,000 copies/mL). She was readmitted to the hospital five days later due to acute graft dysfunction and a repeat biopsy revealed cellular IIA rejection. She completed the first course of brincidofovir but was readmitted for worsening renal function and brincidofovir was restarted due to reemergence of Adenovirus. Due to sepsis requiring ICU management, immunosuppression medications were stopped. On follow-up in the clinic, the patient was found to have glycosuria, phosphouria, hypomagnesemia and hypouricemia consistent with Fanconi syndrome. Aggressive electrolyte repletion was started and Brincidofovir stopped as this was determined to be most likely cause. Electrolyte imbalances gradually improved after stopping brincidofovir.
Discussion
Brincidofovir was utilized as therapy for Adenovirus infection due to its reported lower incidence of nephrotoxicity compared to standard therapy with Cidofovir. However, the side effect of Fanconi syndrome complicated the course of therapy. Fanconi syndrome is a known side effect of cidofovir, and due to brincidofovir’s lower incidence of nephrotoxicity this side effect may not be anticipated. Patients receiving brincidofovir should be monitored for Fanconi syndrome by frequent follow-up, especially electrolytes in the serum and urine.