Case Report: Development of medication-related osteonecrosis of the jaw in a patient on long-term infliximab therapy

Derek Oryniak, Meagan Brown, Lillie Cholakis, Reda Elgazzar
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Abstract

Medication-Related Osteonecrosis of the Jaw (MRONJ) is a challenging and evolving aspect of Oral and Maxillofacial Surgery. In recent years, several medications apart from those traditionally associated with MRONJ such as bisphosphates (BPs) and Denosumab (DMB) have been implicated in bony necrosis of the jaw. This aim of this report is to demonstrate a significant case of bone necrosis following dental extractions on a patient being treated with infliximab therapy for Crohn's disease. Several cases in literature have reported MRONJ associated with infliximab but very few patients have developed as significant a form of the disease as seen in this report. Previous investigators have proposed pathophysiological pathways via which TNF-α inhibitors such as infliximab have a causative mechanism for MRONJ. When osteoclastic activity is restricted via these pathways, bone healing is impaired and MRONJ can occur. However, it remains a diagnostic challenge to differentiate between antiresorptive MRONJ and chronic osteomyelitis with bone necrosis in patients with acquired immunodeficiency. This case aims to illustrate why the antiresorptive effects of TNF-α inhibitors need to be considered as a possible primary driver of bone necrosis in such patients.
病例报告:一名长期使用英夫利西单抗(Infliximab)治疗的患者发生了与药物相关的颌骨坏死
与药物相关的颌骨坏死(MRONJ)是口腔颌面外科一个具有挑战性且不断发展的方面。近年来,除了传统上与 MRONJ 相关的药物外,还有一些药物(如双磷酸盐 (BP) 和地诺单抗 (DMB))也与颌骨坏死有关。本报告旨在展示一例因克罗恩病而接受英夫利昔单抗治疗的患者在拔牙后发生骨坏死的重要病例。有多篇文献报道了与英夫利昔单抗相关的 MRONJ 病例,但很少有患者的病情发展到本报告中的严重程度。先前的研究人员提出了TNF-α抑制剂(如英夫利昔单抗)导致MRONJ的病理生理途径。当破骨细胞的活动通过这些途径受到限制时,骨愈合就会受到影响,从而发生 MRONJ。然而,在获得性免疫缺陷患者中,如何区分抗骨吸收性MRONJ和伴有骨坏死的慢性骨髓炎仍是一项诊断难题。本病例旨在说明为什么需要将TNF-α抑制剂的抗骨吸收作用视为此类患者骨坏死的可能主要驱动因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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