A case of non-clostridial gas gangrene caused by antiresorptive agent-related osteonecrosis of the jaw

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurs in patients who are receiving bisphosphonate preparations, and the clinical features resemble both chronic osteomyelitis and osteonecrosis. Gas gangrene, on the other hand, is rapidly progressive and complicated by sepsis or disseminated intravascular coagulopathy (DIC) and has a very poor prognosis. Gas gangrene more commonly occurs in the extremities, and rare develops in the head and neck region. We describe a 97-year-old woman who presented to our clinic with painful swelling in the buccal region associated with unhealed extraction sockets of the left mandibular canine and first premolar of 2 months duration. Intraorally, there were open extraction sockets of the mandibular left canine and first premolar, associated with bone exposure, purulent discharge, and a sinus track through the cheek. BRONJ with gas gangrene was diagnosed. The patient was hospitalized immediately and underwent surgical drainage and antibiotic treatment. The surgical management was uneventful. The skin defect spontaneously closed 1 month after surgery.