Mandibular Osteonecrosis in a Patient Receiving Denosumab and Sunitinib

Ray Tanaka, Masanao Saito, Tatsuya Abe, Hisao Ajima, Takashi Saku, Takafumi Hayashi


We report a case of osteonecrosis of the jaw (ONJ) in a patient undergoing concurrent treatment with the molecularly targeted agents denosumab and sunitinib for metastatic renal cancer. A 68-year-old man with multiple lung and bone metastases from renal cell carcinoma revisited our institute with exposed bone in the lingual posterior area of the right mandible. The clinical findings were consistent with ONJ according to the diagnostic criteria for bisphosphonate (BP)-related ONJ, although he had not been treated with BPs. His clinical symptoms gradually worsened during conservative treatment with antibiotics; thus, he ultimately underwent surgical treatment after imaging studies confirmed osteomyelitis with necrotic bone and cellulitis of the right mandible. A definitive diagnosis of chronic osteomyelitis with sequestrum formation and no malignancy was made on the basis of histopathological findings. Follow-up clinical and radiological examinations show satisfactory postoperative recovery, and there has been no recurrence of osteonecrosis or osteomyelitis since sequestrectomy, a period of almost 2 years.

J Med Cases. 2015;6(9):393-398


Osteonecrosis of the jaw; Osteomyelitis; Metastatic renal cell carcinoma; Denosumab; Sunitinib; Antiresorptive agents; Antiangiogenic agents

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