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. 2018 Aug;9(2):215-218.
doi: 10.3892/mco.2018.1656. Epub 2018 Jun 14.

Descending necrotizing mediastinitis after sequestrectomy in a patient with bisphosphonate-induced osteonecrosis of the jaw: A case report

Tamaki Tamanuki  1 , Tomoyoshi Aoyagi  1 , Akiyuki Murano  2 , Hiroshi Matsuzaki  1
Affiliations

Descending necrotizing mediastinitis after sequestrectomy in a patient with bisphosphonate-induced osteonecrosis of the jaw: A case report

Tamaki Tamanuki et al. Mol Clin Oncol. 2018 Aug.

Abstract

An 83-year-old woman underwent mastectomy for breast cancer of the right breast in 2008. In addition to hormone therapy and irradiation, zoledronate was started for bone metastasis 6 months postoperatively. Five years after the operation, the patient developed osteonecrosis of the jaw, and underwent sequestrectomy because of uncontrollable pain in the mandible. The patient visited our hospital for a 1-week history of fever and right facial swelling with pain, and was diagnosed with right mandibular cellulitis. Despite antibiotic therapy, the patient fell into shock. Follow-up computed tomography showed gas formation extending down to the posterior mediastinum, which was compatible with descending necrotizing mediastinitis (DNM). The patient succumbed to septicemia on the third hospital day. The mortality rate of DNM greatly increases in patients with advanced cancer because clinicians cannot perform radical treatment due to the impaired general condition and limited life expectancy. DNM advances by the hour; therefore, repeated computed tomography is essential when antibiotic therapy does not improve the patient's condition. Attention must be paid to detect signs of DNM in such patients. To the best of our knowledge, this is the first report in English regarding DNM caused by bisphosphonate-induced osteonecrosis of the jaw.

Keywords: bisphosphonate; bone metastasis; breast cancer; descending necrotizing mediastinitis; osteonecrosis of the jaw.

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Figures

Figure 1.
Figure 1.
Computed tomography on admission. Inflammation in the right mandibular subcutaneous tissue and soft tissue edema was indicated, but neither gas formation nor airway obstruction was demonstrated.
Figure 2.
Figure 2.
Cervical and chest computed tomography 2 days after admission. De novo gas formation extending to the cervical and retropharyngeal spaces down to the posterior mediastinum was indicated. (A) axial, (B) coronal and (C) sagittal view.
Figure 3.
Figure 3.
Entire clinical course for the treatment of breast cancer. Red arrows show cessation periods (2 and 5 months, respectively). BP, Bisphosphonate; DNM, Descending necrotizing mediastinitis; LET, Letrozole; m, Month; ONJ, Osteonecrosis of the jaw; Op, Operation (mastectomy); TOR, Toremifene; y, Year.
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References

    1. Kohno N, Aogi K, Minami H, Nakamura S, Asaga T, Iino Y, Watanabe T, Goessl C, Ohashi Y, Takashima S. Zoledronic acid significantly reduces skeletal complications compared with placebo in Japanese women with bone metastases from breast cancer: A randomized, placebo-controlled trial. J Clin Oncol. 2005;23:3314–3321. doi: 10.1200/JCO.2005.05.116. - DOI - PubMed
    1. Takahashi S, Iwase T, Kohno N, Ishikawa T, Taguchi T, Takahashi M, Horiguchi J, Nakamura S, Hozumi Y, Fukunaga M, Noguchi S. Efficacy of zoledronic acid in postmenopausal Japanese women with early breast cancer receiving adjuvant letrozole: 12-month results. Breast Cancer Res Treat. 2012;133:685–693. doi: 10.1007/s10549-012-1973-0. - DOI - PubMed
    1. Mauri D, Valachis A, Polyzos IP, Polyzos NP, Kamposioras K, Pesce LL. Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: A meta-analysis. Breast Cancer Res Treat. 2009;116:433–439. doi: 10.1007/s10549-009-0432-z. - DOI - PubMed
    1. Valachis A, Polyzos NP, Georgoulias V, Mavroudis D, Mauri D. Lack of evidence for fracture prevention in early breast cancer bisphosphonate trials: A meta-analysis. Gynecol Oncol. 2010;117:139–145. doi: 10.1016/j.ygyno.2009.12.001. - DOI - PubMed
    1. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63:1567–1575. doi: 10.1016/j.joms.2005.07.010. - DOI - PubMed