メトトレキサート関連リンパ増殖性疾患により顎骨壊死をきたした1例

• Published in: 日本口腔外科学会雑誌 Vol. 60; no. 4; pp. 229 - 233
• Main Authors: 後藤, 育子, 石田, 優, 渋谷, 恭之, 古森, 孝英, 竹内, 純一郎, 古土井, 春吾
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.04.2014
• Subjects: メトトレキサート関連リンパ増殖性疾患; 顎骨壊死
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.60.229

We report a case of methotrexate-associated lymphoproliferative disorder （MTX-LPD） with osteonecrosis of the maxilla. A 74-year-old woman who had been treated for 10 years with methotrexate （MTX） and steroids for rheumatoid arthritis was found to have pain after tooth extraction of the left upper cuspid. We performed a computed tomographic examination and a biopsy, and the pathological diagnosis was granulation tissue formation. We diagnosed this lesion as incomplete healing after extraction, and followed up the patient with oral management. However, the patient’s symptoms suddenly worsened, and we performed another biopsy for a suspected tumor. The pathological diagnosis was MTX-LPD. The local pain disappeared after MTX therapy was stopped. On the 35th day after discontinuation, a sequestrum was isolated from the maxilla under local anesthesia. After the operation, the wound was covered with mucosal epithelium, and there has been no recurrence to date.