Osteonecrosis of the jaw in an AIDS patient: a case report

Abstract

We report a rare case of osteonecrosis of the jaw following necrotizing gingivitis in a Japanese AIDS patient. Intraoral examination showed exposed necrotic bone in the left mandible and spontaneous loss of teeth. This patient was successfully treated with highly active anti-retroviral therapy combined with minimally invasive surgical procedures to remove the osteonecrosis of the jaw.

Keywords: AIDS; HAART; Osteonecrosis of the jaw.

Figure 1

Findings on admission. A) Left mandible with denudation of bone, spontaneous loss of the teeth, necrotizing gingivitis and stomatitis. B) Orthopantomography show ill-defined, irregular bony destruction in the left mandible. C) Gallium-67 citrate scintigraphy shows abnormal uptake in the left mandible.

Figure 2

Changes in appearance on 3D-CT from on admission. (A) to the 2-month follow-up examination (B). A) 3D-CT showed ill-defined, irregular destruction of cortical bone in the left mandible on admission. B) Sequestra of the mandible were seen as radiopaque areas resembling “islands of bone” at the 2-month follow-up.

Figure 3

Appearance at the 6-month follow-up examination. In the absence of radical surgery, spontaneous exfoliation of sequestrum is observed, showing spontaneous expulsion through the mucosa. A) Extensive scarring is seen around the mandibular defect. B) On 3D-CT, the living bone is seen to be very thin in the left mandible.

Figure 4

Treatments and changes in HIV-RNA viral load and CD4 count. Viral load decreased from 2.5 × 10⁵ copies/mL to <44 × 10⁵ copies/mL with treatment. During the first 10 months after treatment, CD4+ lymphocyte count increased from 78 cells/μL to 280 cells/μL.