FISTULAS AND CELLULITIS CAUSED BY ASSOCIATION OF BISPHOSPHONATES AND MONOCLONAL ANTIBODY IN AN EDENTULOUS PATIENT

Abstract

Antireabsorbents such as bisphosphonates and monoclonal and antiangiogenic antibodies may lead to osteonecrosis of the jaw. The pathways with which this phenomenon happens depend on the drug. Bisphosphonates act on the mevalonate chain by blocking enzymes that signal osteoclastic activity, and monoclonal antibodies act on the RANKL/osteoprotegerin system. Studies have shown that the association of both may potentialize the effect of osteonecrosis. A patient, 80 years old, had sudden facial edema and intrabuccal erythema in the tooth region 37, with pain, erythema, and local temperature increase and whose diagnosis was osteonecrosis. The patient was treated with clindamycin 300 mg and conservative treatment with an antiseptic. The condition progressed to a fistula, cellulitis, and then to the contralateral side. After suspension of denosumab, the lesions regressed and there were no signs at the 18-month follow-up.