We report a case of Fanconi syndrome associated with the use of tenofovir disoproxil fumarate, a nucleotide reverse transcriptase inhibitor used in the treatment of HIV infection. A 56-year-old HIV-infected man was admitted to the hospital with a chief complaint of severe, progressive weakness. His HIV infection was well controlled by antiretroviral therapy; other medical problems included hepatitis C and chronic renal insufficiency. About 2 weeks before presentation, the patient had received an influenza vaccination, which was followed by a generalized viral syndrome of several days' duration. Next, weakness developed and culminated in an inability to walk; this prompted the patient's presentation at the hospital. Urine chemistry, electrolyte panel, and clinical presentation were consistent with Fanconi syndrome, a generalized proximal tubular dysfunction involving proteins, glucose, uric acid, and electrolytes. Along with our Case Report, we review 25 cases of Fanconi syndrome previously reported in the literature.