A case of intractable medication-associated osteonecrosis of the jaw complicated by cervical abscess and sepsis

[ABSTRACT] 【Background】Osteonecrosis of the jaw (ONJ) induced by bone resorption inhibitors is termed medication-related ONJ (MRONJ). Some papers have reported that bisphosphonates can cause MRONJ complicated by infections. However, there are few case reports of MRONJ associated with denosumab, and the detailed clinical course is unknown. This case report presents a case of MRONJ caused by bisphosphonate and denosumab, which was complicated by cervical abscess and sepsis.【Case report】A 70-year-old woman was previously diagnosed with lung cancer with bone metastasis. Denosumab was subsequently administered along with a course of chemotherapy and radiation therapy for the cancer. Two years later, she developed ONJ on the right side, possibly due to denosumab, and treatment was initiated with irrigation and antibiotic administration. Despite continuous irrigation and antibiotic administration, she developed a cervical abscess with surrounding cellulitis and sepsis. The patient was immediately admitted for intensive care. The cervical abscess was surgically drained, and tracheostomy and artificial ventilation were performed due to the risk of airway obstruction after the cervical surgery. Antibiotic treatment was also continued. The patient recovered after intensive multidisciplinary treatments and was discharged 43 days after her hospitalization. No recurrence of the abscess was observed over the following 6 months with continual oral cleaning.【Conclusion】MRONJ can be complicated with potentially fatal infections around the soft tissue and other regions around the jaw. Early diagnosis, appropriate management, and careful follow-up are necessary and should be conducted by a multidisciplinary team, including dentists.