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A series of complications after third molar osteotomy in a pancytopenia patient and spontaneous healing after bone marrow transplantation
- Source :
- Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 69(10)
- Publication Year :
- 2010
-
Abstract
- Complications can result from the surgical removal of third molars, and the complication rate is expected to be higher in immunosuppressed patients. However, such cases are rare. Leflunomide is a slow-acting antirheumatic agent used in the treatment of rheumatoid arthritis and psoriatic arthritis. It inhibits dihydroorotate dehydrogenase, a key enzyme in pyrimidine metabolism that is particularly significant in the cell division of T lymphocytes, and suppresses leukocyte migration. In the intestinal wall and the liver, leflunomide is converted into its active metabolite, A771726, which is further metabolized into additional active substances. The half-life of these active leflunomide metabolites is between 1 and 4 weeks. Known side effects of leflunomide are itching, mucous membrane lesions, hair loss (alopecia), diarrhea, and very rarely, agranulocytosis and fatal liver necrosis. Combination therapies with leflunomide and other basic antirheumatic drugs such as methotrexate and chloroquine are more effective than monotherapy and are widely used in nonsurgical rheumatology. However, the combination of leflunomide and methotrexate is associated with the risk of severe liver damage (eg, granulomatous hepatitis) and/or lifethreatening infections. Furthermore, the risks of longterm treatment with such a combination therapy are not yet well-known. We report for the first time a case of life-threatening complications after surgical removal of the infected mandibular third molar in a patient with leflunomideinduced pancytopenia.
- Subjects :
- Adult
medicine.medical_specialty
Leukocyte migration
Combination therapy
Pancytopenia
Cutaneous Fistula
Platelet Transfusion
Gastroenterology
Arthritis, Rheumatoid
Psoriatic arthritis
Immunocompromised Host
Internal medicine
medicine
Humans
Mucormycosis
Mandibular Diseases
Leflunomide
Bone Marrow Transplantation
business.industry
Focal Infection, Dental
Clindamycin
Osteomyelitis
Isoxazoles
Pneumonia
medicine.disease
Surgery
Anti-Bacterial Agents
Osteotomy
Otorhinolaryngology
Rheumatoid arthritis
Antirheumatic Agents
Dental Care for Chronically Ill
Pyrimidine metabolism
Tooth Extraction
Methotrexate
Female
Molar, Third
Oral Surgery
business
Negative-Pressure Wound Therapy
medicine.drug
Subjects
Details
- ISSN :
- 15315053
- Volume :
- 69
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
- Accession number :
- edsair.doi.dedup.....8c5894ba3c095e9e59c0fc6beba9007e