MEDICATION-RELATED OSTEONECROSIS OF THE JAWS IN A PATIENT WITH RHEUMATOID ARTHRITIS AND SECONDARY INFECTION BY SERRATIA MARCESCENS

Bisphosphonates are drugs indicated for the treatment of osteoporosis, bone tumors, and bone metastases. However, these patients may eventually develop necrosis of jaw bones recognized as medication-related osteonecrosis of the jaws (MRONJ). Treatment of this complication could be a challenge. The main triggering factor is a dental extraction. A 72-year-old woman with rheumatoid arthritis and using alendronate for several years underwent dental extraction 7 years ago. However, the socket did not heal. The patient remained with MRONJ for 5 years. Clinical evaluation found an area of bone exposure in the inferior alveolar ridge with drainage of purulent secretion. Serratia marcescens was detected, and the antibiotic was replaced. Although improvement was achieved, the bone exposure persisted with subsequent episodes of purulent drainage. Therefore, surgical resection was performed, and the necrotic bone was removed. Total healing was observed, and the patient is in follow-up for 2 years without recurrence.