Successful denosumab treatment for central giant cell granuloma in a 9-year-old child

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.