Chronic Fatigue Syndrome and Bone Marrow Defects of the Jaw – A Case Report on Additional Dental X-Ray Diagnostics with Ultrasound

Abstract

Purpose

This paper aims to demonstrate the additional benefit of ultrasound in the diagnosis of chronic osteolysis and osteonecrosis (bone marrow defects) of the jaw shown in a clinical case report.

Patients and Methods

A case of chronic fatigue syndrome (CFS) in a young man presenting the typical, ambiguous symptoms, which were accompanied by headaches and tinnitus. X-ray techniques, namely panoramic radiographs (OPG) and cone beam computed tomography (DVT/CBCT), failed to produce any remarkable findings of bone marrow defects (BMDJ) in the jawbone. However, the measurement of bone density using trans-alveolar ultrasound (TAU) indicated a possible bone marrow defect in the lower left jawbone.

Results

Surgery was undertaken at the conspicuous area. Additional to softened, ischemic, fatty tissue, a black area was revealed, which was surprisingly subsequently identified as aspergillosis by histopathological analysis. In addition, the excessive local RANTES/CCL5 expression found in the affected area confirmed the necessity for surgical debridement and additional findings of TAU.

Conclusion

In contrast to radiography, complementary TAU imaging of the BMDJ revealed chronic inflammatory signaling RANTES/CCL5 pathways and fungal colonization. This case report supports the need for additional diagnostic techniques beyond radiographic modalities, which can help to elucidate the diagnostic composition and knowledge of the bone manifestations of systemic diseases.

Keywords:

• chronic fatigue syndrome
• radiographic diagnostics
• bone marrow defect
• osteonecrosis
• RANTES/CCL5
• trans-alveolar ultrasonography

Acknowledgments

English-language editing of this manuscript was provided by Natasha Gabriel.

Disclosure

CaviTAU^® (Munich, Germany), the company that designed the new TAU apparatus and associated software, provided this equipment without charge for the purposes of this report. The ultrasonography procedure was carried out at the Clinic for Integrative Dentistry (Munich, Germany). CaviTAU^® and the Clinic for Integrative Dentistry are engaged in ongoing discussions to further improve and verify the new TAU apparatus, CaviTAU^®, as it is introduced to the market. The author is the holder of a patent PTC/EP2018/084199 used in the CaviTAU^®. The authors report no other conflicts of interest in this work.