APPROACH TO THE DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE MYELOMA OR OSTEONECROSIS: A CASE REPORT

Abstract

A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified. A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified.