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Successful denosumab treatment for central giant cell granuloma in a 9‐year‐old child
Author(s) -
Mariz Bruno Augusto Linhares Almeida,
Migliorati César Augusto,
Alves Fabio de Abreu,
Penteado Fabiana de Moraes,
Carvalho Neviçolino Pereira,
SantosSilva Alan Roger,
Rocha André Caroli
Publication year - 2021
Publication title -
special care in dentistry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.328
H-Index - 41
eISSN - 1754-4505
pISSN - 0275-1879
DOI - 10.1111/scd.12588
Subject(s) - medicine , denosumab , surgery , vomiting , discontinuation , osteonecrosis of the jaw , bisphosphonate , osteoporosis
Background Denosumab is a nonsurgical treatment option for central giant cell granulomas (CGCG), especially in aggressive lesions. Case report We describe a 9‐year‐old girl with an aggressive maxillary CGCG successfully treated with denosumab, avoiding a mutilating surgery after intralesional corticosteroid injections failed, and the lesion continued to rapidly grow. During denosumab treatment, she developed a self‐limiting area of osteonecrosis in the maxillary alveolar bone, which rapidly resolved after antibiotic therapy. Six months after denosumab discontinuation, a maxillary surgical recontour was performed. Two weeks after surgery, the patient presented vomiting, pallor, dehydration, but no fever. Blood tests revealed severe hypercalcemia and acute renal dysfunction. After discarding thyroid, parathyroid, and adrenal alterations, a diagnosis of severe rebound hypercalcemia after denosumab treatment was made. Treatment consisted of hyperhydration, calcium pamidronate, and methylprednisolone, restoring calcium levels to normal. Conclusion After 2 years of follow‐up, she remains on orthodontic treatment, with no recurrences or other episodes of hypercalcemia.