Osteonekrose i maksillen hos patient uden historik med antiresorptiv medicin

Background
Medication-related osteonecrosis of the jaw (MRONJ) is defined by exposed bone for more than eight weeks in patients with a history of antiresorptive treatment alone or in combination with immune modulators or antiangiogenic medications. Local and systemic risk factors are known to increase the risk of developing MRONJ.

Case study
A 74-year-old male with diffuse large B-cell lymphoma and treatment-related myelodysplastic syndrome developed osteonecrosis in the anterior maxilla and hard palate. The patient was immunocompromised and had received treatment with the monoclonal antibody Rituximab four years prior to his MRONJ diagnosis and was in treatment with Azacitidine at the time of diagnosis.

Conclusion
The patient had not received treatment with any antiresorptive medications that are normally associated with MRONJ. The association between Rituximab, Azacitidin and MRONJ is not well understood, and consequently further studies are warranted.