title: Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the jaw in a patient with multiple myeloma.
abstract: A 60-year-old man with multiple myeloma (MM) (IgG-kappa, stage IIIA) had been treated with minodronate at 6 mg orally as a phase 1 clinical trial for myeloma bone disease for 13 months (total dose, 4032 mg). Then he received incadronate at 10mg intravenously every 1 to 4 weeks (total dose, 350 mg). In July 2005, he complained of mild right mandibular pain, and bone scintigram showed a hot spot at the right side of the mandible. Panoramic radiograph showed osteonecrosis of the jaw (ONJ) and axial and 3-dimensional computed tomography confirmed ONJ. Oral examination showed massive gingival swelling of the right side of the mandible without exposed necrotic bone. He was given clarithromycin in addition to levofloxacin, followed by hyperbaric oxygen (HBO) therapy, which resulted in the complete disappearance of the pain. This is a first reported case of ONJ induced by incadronate. The present case suggests that early detection of ONJ by regular dental check-ups is important in the management of patients with MM who have received bisphosphonate therapy, and HBO in combination with antibiotic therapy is effective in the early stage of ONJ.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Shimura
authors.forename: Chihiro
authors.initials: C
authors.lastname: Shimazaki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Sonoko
authors.initials: S
authors.lastname: Akamatsu
authors.forename: Masashi
authors.initials: M
authors.lastname: Okamoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Uchida
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Nomura
authors.forename: Tohru
authors.initials: T
authors.lastname: Inaba
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horiike
authors.forename: Narisato
authors.initials: N
authors.lastname: Kanamura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003952:Diagnostic Imaging / Q000379:methods; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007571:Jaw Diseases / Q000175:diagnosis; D008297:Male; D008334:Mandible / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D010146:Pain; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004164:Diphosphonates; C071542:cimadronate