Actinomycosis Associated with Drug-Induced Mandibular Osteonecrosis
Keywords:
osteonecrosis; mandible; bisphosphonates; actinomycosis; drug-related maxillary osteonecrosisAbstract
Introduction: Drug-related osteonecrosis of the jaws is a complication characterized by exposed necrotic bone for at least eight weeks, linked to the use of antiresorptive drugs such as bisphosphonates or nuclear factor kappa B receptor inhibitors. Colonization by Actinomyces has gained significance in its pathogenesis, as numerous studies have shown a high prevalence of its presence in histological specimens.
Objective: To present a clinical case of drug-induced mandibular osteonecrosis with histopathological evidence of Actinomyces colonization.
Case Report: We describe a 71-year-old woman with lung cancer and bone metastases, undergoing treatment with erlotinib and intravenous zoledronic acid, who developed purulent discharge following a tooth extraction. After initial medical treatment failed, a surgical biopsy and culture were performed, confirming Actinomyces infection. A literature review was conducted to contextualize its diagnostic and therapeutic implications.
Results: After confirming Actinomyces infection, antibiotic treatment was modified to a prolonged regimen with beta-lactams combined with surgical intervention, resulting in a favorable outcome. Previous studies report the presence of Actinomyces in 114 patients (82% positive) with drug-induced mandibular osteonecrosis; meanwhile, in a cohort of 111 patients with a similar condition, the presence of this microorganism was detected in 89% of them via histology.
Conclusions: Identifying Actinomyces in the context of maxillofacial surgery is essential, as it requires a combined approach of antibiotic therapy and, at times, surgical intervention. Its detection improves the prognosis and allows for more effective and personalized treatment.
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