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Abstract：
Recognizing rare but clinically significant toxicity of immunotherapy is critical. Here we describe the first detailed case of severe osteonecrosis of the jaw due to anti-PD-1. A 75-year-old man with metastatic melanoma, with no prior radiation or treatment with bone-targeting agents, experienced jaw pain 1 week after his first dose of nivolumab. Imaging studies were negative, and treatment was resumed after pain was controlled. 4 months later, the patient experienced acute exacerbation of pain and malocclusion of the jaw. Imaging showed bilateral fractures of the angle of mandible with extensive disruption of the normal trabecular architecture, requiring total mandibulectomy. The patient\'s metastatic melanoma responded to treatment and remains controlled >20 months after treatment cessation without further therapy.
摘要：
认识到免疫疗法的罕见但具有临床意义的毒性至关重要。在这里，我们描述了由于抗PD-1引起的严重颌骨坏死的第一例详细病例。一个75岁的转移性黑色素瘤患者,事先没有放射或使用骨靶向剂治疗，首次服用纳武单抗后1周出现下颌疼痛.影像学检查阴性,疼痛控制后恢复治疗。4个月后,患者经历了疼痛和颌骨错合的急性加重。影像学显示双侧下颌骨角骨折，正常骨小梁结构广泛破坏，需要进行下颌骨全切除术.患者的转移性黑色素瘤对治疗有反应，并在治疗停止后>20个月保持控制，无需进一步治疗。
