Sunitinib is commonly used in the treatment of patients with
renal cell carcinoma and is associated with serious side-effects. We present the first report of a recurrent submandibular
fistula in a patient treated with
sunitinib. A 68-year-old man was referred to our clinic for a
cutaneous fistula situated on the right side of his lower jaw. The patient had been diagnosed with bone
metastases from a
renal carcinoma 2 years ago and had received a single 4 mg dose of
zoledronic acid and subsequent treatment with
sunitinib 37.5 mg once daily for the past 4 weeks. The patient was treated surgically by a perilesional incision and primary closure with
sutures, advised on meticulous
oral hygiene and was kept on an
antimicrobial agent in the form of
clindamycin. After reinitiating his oncological treatment with
sunitinib the
cutaneous fistula re-appeared and bone abnormalities were also detected on his X-ray. After 18 months a contralateral
cutaneous fistula was observed along with a spontaneous avulsion of the patient's left molar. Repeat surgical treatment and sequestrectomy was performed with the subsequent histopathological examination revealing a suspicion of
osteonecrosis of the jaw and an associated
Actinomyces infection.