Zoledronic acid
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Suppurative arthritis associated with bisphosphonate-related osteonecrosis of the jaw in an elderly patient: case report A 70-year-old man developed suppurative arthritis of the temporomandibular joint (TMJ) associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) following treatment with zoledronic acid. The man received monthly IV infusions of zoledronic acid [dosage not stated] from April 2008 to March 2010 due to prostate carcinoma with distant bone metastasis. In November 2010 he presented with severely restricted mouth opening and pain in his left TMJ. Left-sided preauricular swelling was noted and he had a maximal incisor opening of 10mm. TMJ pain on mouth opening scored 8.0 on the visual analogue scale (VAS). His second and third left mandible molars had periodontal disease and visible root surfaces. In the same area, the alveolar bone was exposed and there was severe inflammation of the surrounding soft tissue. Blood tests revealed leucocytosis with a polymorphonuclear left cell shift and a CRP level of 15.1 mg/dL. MRI revealed intra-articular fluid collection in the left condylar region with lower and upper capsular distension on T2-weighted images. He was diagnosed with suppurative arthritis of the TMJ associated with BRONJ. The man received broad-spectrum antibiotics and aspiration of his left TMJ was performed. White yellowish fluid collected from the area was sent for culture and grew Prevotella buccae, Haemophilus, and Streptococcus. His antibiotic therapy was switched to meropenem. A preauricular lateral incision was made and daily irrigation performed. After 2 months of irrigation, his second and third molars fell out. His VAS score for TMJ pain improved to 1.0. After 3 months, the TMJ fistula was still present with exposed bone in the left mandible cavities. He continued to receive local irrigation and there was no evidence of acute infection. Author comment: "This is the first report of suppurative arthritis of the TMJ associated with chronic [bisphosphonate] therapy. . . The original infection was BRONJ." Enomoto A, et al. Suppurative arthritis of the temporomandibular joint associated with bisphosphonate: a case report. Journal of Oral and Maxillofacial Surgery 70: 803076767 1376-9, No. 6, Jun 2012 - Japan
0114-9954/10/1418-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 8 Sep 2012 No. 1418
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