Tenofovir disoproxil fumarate (TDF) is an anti-retroviral drug that is known to cause nephrotoxicity including renal tubular acidosis (RTA). With increasing literature on proximal RTA caused by TDF, reports on distal RTA are scarce, with only one case reported so far. We report a case of distal RTA in patient living with human immunodeficiency virus, who presented with nausea and fatigue giving a history of TDF-based therapy for two years. Laboratory investigations revealed non-anion gap metabolic acidosis, positive urine anion gap, hyperchloremia, and hypokalemia. The patient improved after discontinuing TDF and supportive management.
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