Osteonecrosis of the jaw in a patient with acute myeloid leukemia, who received azacitidine

Abstract

The first case of osteonecrosis of the jaw (ONJ) related to azacitidine therapy was reported. A 64-year-old male with acute myeloid leukemia, who received 5-azacitidine, presented with pain and purulence of the right second premolar. An unsuccessful endodontic therapy resulted in dental extraction 6 months later. The post-extraction non-healing socket was managed with antibiotics and multiple surgical debridements without response. ONJ stage 2 was diagnosed 12 months after the initial symptoms of pain and purulence and was managed conservatively. Currently the patient is still receiving 5-azacitidine therapy, while ONJ remains asymptomatic. This case highlights the presence of alveolar bone disease prior to the appearance of ONJ. Osteonecrosis in chemotherapy, although rare, may increase as long-term survival of cancer patients, who receive those medications increases. Health care professionals need to be alert, while collaboration with an experienced oral/dental oncologist would be beneficial to the patient.

Keywords

Key words: Acute myeloid leukemia / azacitidine / periodontal/dental disease and infection / dental extraction / osteonecrosis of the jaw

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