Osteonecrosis of the Jaw in a Crohn’s Disease Patient following Infliximab Therapy: A Case Report and Literature Review

Authors

  • Andreas Sakkas Department of Oral, Maxillofacial and Facial Plastic Surgery, Klinikum Ludwigshafen (Hospital), Ludwigshafen, Germany
  • Sebastian Heil Department of Oral, Maxillofacial and Facial Plastic Surgery, Klinikum Ludwigshafen (Hospital), Ludwigshafen, Germany
  • Steffen Kargus Department of Oral, Maxillofacial and Facial Plastic Surgery, Klinikum Ludwigshafen (Hospital), Ludwigshafen, Germany
  • Oliver Thiele Department of Oral, Maxillofacial and Facial Plastic Surgery, Klinikum Ludwigshafen (Hospital), Ludwigshafen, Germany
  • Robert Mischkowski Department of Oral, Maxillofacial and Facial Plastic Surgery, Klinikum Ludwigshafen (Hospital), Ludwigshafen, Germany

DOI:

https://doi.org/10.31907/2414-2093.2020.06.04

Keywords:

Medication-Related Osteonecrosis of the Jaw, Infliximab, TNF-a Inhibitors, Crohn's Disease and Osteomyelitis.

Abstract

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication, occurring to patients undergoing treatment with antiresorptive medication, such as bisphosphonates, denosumab or bevacizumab, for different oncologic and non-oncologic diseases. The aim of this study is to report a case of MRONJ in a young patient treated with infliximab, a tumor necrosis factor-a inhibitor used in the treatment of immune-mediated inflammatory diseases such Crohn's disease, ulcerative colitis, ankylosing spondylitis, rheumatoid and psoriatic arthritis. Case Report: A 27-year-old female patient diagnosed with Crohn's disease, who had been undergoing intravenous infliximab therapy every seven weeks for 8 years, sought our oral and plastic maxillofacial department with a peri-mandibular abscess for further treatment. The patient underwent surgical treatment, including the extraoral sub-mandibular incision of the abscess and the extraction of the lower second premolar under the administration of intravenous antibiotics. We traced a wound dehiscence and delayed healing procedure of the extraction's alveolar bone, and five weeks later, the patient returned with an abscess recurrence around the mandibular angle area. The patient underwent surgical treatment with wide bone resection and debridement of the necrotic tissues. After follow-up (4 months), the patient completely healed without signs of recurrence. Discussion: Osteomyelitis of the jaw by patients treated with infliximab has been sparsely described in publications. This case confirms the potential role of infliximab in the pathogenesis of MRONJ. Since the pathomechanism of MRONJ under infliximab therapy remains unclear, we recommend a regular oral check-up before starting therapy, as well as during the therapy with infliximab, in order to possibly prevent the MRONJ onset.`

References

Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaws – 2014 update. J Oral Maxillofac Surg. 2014;72(10):1938–56. https://doi.org/10.1016/j.joms.2014.04.031

Ramírez L, López-Pintor RM, Casañas E, et al. New non-bisphosphonate drugs that produce osteonecrosis of the jaws. Oral Health Prev Dent. 2015;13(5):385–93.

Fleisher KE, Jolly A, Venkata UD, et al. Osteonecrosis of the jaw onset times are based on the route of bisphosphonate therapy. J Oral Maxillofac Surg. 2013;71:513–19. https://doi.org/10.1016/j.joms.2012.07.049

Marx RE, Cillo JE, Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2007;65:2397–410. https://doi.org/10.1016/j.joms.2007.08.003

Santos-Silva AR, Belizário Rosa GA, et al. Osteonecrosis of the mandible associated with bevacizumab therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(6):e32–36. https://doi.org/10.1016/j.oooo.2013.02.001

Pichardo SE, van Merkesteyn JP. Evaluation of a surgical treatment of denosumab-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(3):272–78. https://doi.org/10.1016/j.oooo.2016.03.008

Preidl RHM, Ebker T, Raithel M, et al. Osteonecrosis of the jaw in a Crohn’s disease patient following a course of bisphosphonate and adalimumab therapy: A case report. BMC Gastroenterology. 2014;14:6. https://doi.org/10.1186/1471-230x-14-6

Cassoni A, Romeo U, Terenzi V, et al. Adalimumab: Another medication related to osteonecrosis of the jaws? Case Rep Dent. 2016;2016:2856926. https://doi.org/10.1155/2016/2856926

Fleissig Y, Regev E, Lehman H. Sunitinib related osteonecrosis of jaw: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):e1–e3. https://doi.org/10.1016/j.tripleo.2011.06.023

Lescaille G, Coudert AE, Baaroun V, et al. Clinical study evaluating the effect of bevacizumab on the severity of zoledronic acid-related osteonecrosis of the jaw in cancer patients. Bone. 2014;58:103– 7. https://doi.org/10.1016/j.bone.2013.10.002

Scheinfeld N. A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab. J Dermatolog Treat. 2004;15(5):280–94. https://doi.org/10.1080/09546630410017275

Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacol Ther 2008;117:244–79. https://doi.org/10.1016/j.pharmthera.2007.10.001

Preidl RHM, Ebker T, Raithel M, Wehrhan F, Neukam FW, Stockmann P. Osteonecrosis of the jaw in a Crohn’s disease patient following a course of bisphosphonate and adalimumab therapy: a case report. BMC Gastroenterol 2014;14:1–6. https://doi.org/10.1186/1471-230x-14-6

Cassoni A, Romeo U, Terenzi V, Della Monaca M, Rajabtork Zadeh OR, Raponi I, Fadda MT, Polimeni A, Valentini V. Adalimumab: another medication related to osteonecrosis of the jaws? Case Rep Dent 2016;2016:1–6. https://doi.org/10.1155/2016/2856926

Favia G, Tempesta A, Limongelli L, Crincoli V, Iannone F, Lapadula G, Maiorano E. A case of osteonecrosis of the jaw in a patient with Crohn’s disease treated with infliximab. Am J Case Rep 2017;18:1351–6. https://doi.org/10.12659/ajcr.905355

Ebker T, Rech J, von Wilmowsky C, Neukam FW, Stockmann P. Fulminant course of osteonecrosis of the jaw in a rheumatoid arthritis patient following oral bisphosphonate intake and biologic therapy. Rheumatology (Oxford) 2013;52:218–20. https://doi.org/10.1093/rheumatology/kes351

Ciantar M, Adlam DM. Treatment with infliximab: Implications in oral surgery? A case report. Br J Oral Maxillofac Surg. 2007;45(6):507–10. https://doi.org/10.1016/j.bjoms.2006.06.004

Brijs K, Miclotte I, Vermeire S, Darche V, Politis C. Osteonecrosis of the jaw in patients with inflammatory bowel disease treated with tumor necrosis factor alpha inhibitors. Int J Oral Maxillofac Surg. 2019 Aug 27. pii: S0901- 5027(19)31274-3. https://doi.org/10.1016/j.ijom.2019.08.007

Pichardo SE, van Merkesteyn JP. Evaluation of a surgical treatment of denosumab-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(3):272–78. https://doi.org/10.1016/j.oooo.2016.03.008

Sivolella S, Lumachi F, Stellini E, Favero L. Denosumab and anti-angiogenetic drug-related osteonecrosis of the jaw: An uncommon but potentially severe disease. Anticancer Res. 2013;33(5):1793–97.

Pakosch D, Papadimas D, Munding J, et al. Osteonecrosis of the mandible due to antiangiogenic agent, bevacizumab. Oral Maxillofac Surg. 2013;17:303–6. https://doi.org/10.1007/s10006-012-0379-9

Allegra A, Oteri G, Alonci A, et al. Association of osteonecrosis of the jaws and POEMS syndrome in a patient assuming rituximab. J CranioMaxillofac Surg. 2014;42:279–82. https://doi.org/10.1016/j.jcms.2013.05.014

Fleissig Y, Regev E, Lehman H. Sunitinib related osteonecrosis of jaw: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):e1–e3. https://doi.org/10.1016/j.tripleo.2011.06.023

Cassoni A, Romeo U, Terenzi V, et al. Adalimumab: Another medication related to osteonecrosis of the jaws? Case Rep Dent. 2016;2016:2856926. https://doi.org/10.1155/2016/2856926

Sandborn WJ, Hanauer SB. Antitumor necrosis factor therapy for inflammatory bowel disease: A review of agents, pharmacology, clinical results, and safety. Inflamm Bowel Dis. 1999;5:119–33. https://doi.org/10.1097/00054725-199905000- 00008

Favia G, Tempesta A, Limongelli L, et al. Medication-related osteonecrosis of the jaws: Considerations on a new antiresorptive therapy (Denosumab) and treatment outcome after a 13- year experience. Int J Dent. 2016;2016:1801676. https://doi.org/10.1155/2016/1801676

Khan AA, Morrison A, Hanley DA, et al. Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. J Bone Miner Res. 2015;30(1):3–23. https://doi.org/10.1002/jbmr.2593

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014 Dec;12(12):1500-24. https://doi.org/10.1016/j.ijsu.2014.07.014

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2020-10-15

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