メトトレキサート関連リンパ増殖症患者に生じたビスフォスフォネート関連顎骨壊死の悪化にトシリズマブが関与したと思われる1例

DOI Web Site 被引用文献6件 参考文献12件
  • 合田 啓之
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野
  • 中城 公一
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野
  • 日野 聡史
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野
  • 田中 宏史
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野
  • 浜川 知大
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野
  • 浜川 裕之
    愛媛大学大学院医学系研究科口腔顎顔面外科学分野

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タイトル別名
  • Possible negative effect of tocilizumab on BRONJ in a patient with methotrexate-associated lymphproliferative disorder
  • メトトレキサート カンレン リンパ ゾウショクショウ カンジャ ニ ショウジタ ビスフォスフォネート カンレン ガッコツ エシ ノ アッカ ニ トシリズマブ ガ カンヨ シタ ト オモワレル 1レイ
  • Possible negative effect of tocilizumab on BRONJ in a patient with methotrexate-associated lymphoproliferative disorder

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Tocilizumab, a humanized anti-interleukin 6 receptor antibody, has been reported to be effective for chronic rheumatoid arthritis (RA) in clinical trials and was approved in Japan for the first time in the world in April 2008. We report a patient with methotrexate (MTX)-associated lymphoproliferative disorder in whom bisphosphonate-related osteonecrosis of the jaw (BRONJ) was exacerbated by concurrent treatment with tocilizumab. <br>A 60-year-old woman was referred to our department by her dentist because of diffuse swelling of the right submandibular region and a right lower gingival ulcer. Computed tomography showed extensive swelling of the cervical, axillary, subscapular, and inguinal lymph nodes. Her medical history included RA. She had received MTX and sodium risedronate hydrate. Her past medical history and present illness strongly suggested BRONJ. Bisphosphonate administration was terminated, and BRONJ was treated conservatively with antibiotics and local irrigation. Because RA was getting worse, she was given tocilizumab. Subsequently, gingival necrosis and BRONJ was apparently exacerbated. Tocilizumab and MTX were withdrawn, and she received antibiotics and surgical treatment. There have been no signs of recurrence for 18 months.

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