Medication-Related Osteonecrosis of the Jaw in a Patient with Nonuremic Calciphylaxis

A 62-year-old man was referred to the emergency department of our hospital with pain and swelling in the left mandibular region that had evolved over the previous 2 months (Figure 1). His medical history included nonuremic calciphylaxis and systemic sclerosis (Figure 2). Since the diagnosis of the nonuremic calciphylaxis 5 years before, the patient had been treated with intravenous (IV) sodium pamidronate 60 mg per week for 11 months, without improvement, followed by IV sodium thiosulfate 25 mg twice a week for 18 month. During year 3 of treatment, the calciphylaxis lesions reappeared, and IV sodium pamidronate 60 mg per week was reintroduced to the patient's treatment. The patient remained with double treatment for the next 2 years, but 3 months before the patient's presentation, the IV treatment had been suspended due to an absence of peripheral venous access.