治療に難渋したビスホスホネート関連顎骨壊死の1例

Abstract

A 65-year-oldman with urination difficulty visited our hospital. Because his prostate-specific antigen level was 1, 619 ng/ml, we performeda prostate biopsy. The biopsy specimen yielded a diagnosis of adenocarcinoma with a Gleason score of 4＋4. Computedtomography and bone scintigraphy showed lymph node, lung, and bone metastasis (cT3bN1M1). After 13 months of combined androgen blockade, he underwent treatment with a bisphosphonate. At 22 months of treatment, he developed bisphosphonaterelated osteonecrosis of the jaw, andall necrotic bone and teeth were removed. He subsequently underwent repeated cleaning and fixation (splinting) for an oral fistula andmand ibular fracture. Emergency transcatheter arterial embolization was then performed to treat a bleeding of the facial artery aneurysm. An oral infection and aspiration pneumonia repeatedly developed secondary to the oral fistula. The patient underwent a gastrostomy, after which his nutritional status improved and he was discharged.