Key Clinical Message Chronic use of bisphosphonates, in combination with immunosuppressive therapy, increases the risk of jaw osteonecrosis. When sepsis occurs in patients receiving bisphosphonate, osteonecrosis of the jaw should be considered a potential source of infection. Abstract Reports of medication‐related osteonecrosis of the jaw (MRONJ) accompanied by sepsis are limited. A 75‐year‐old female patient with rheumatoid arthritis, receiving treatment with bisphosphonate and abatacept, developed sepsis secondary to MRONJ. When sepsis occurs in patients receiving bisphosphonate, osteonecrosis of the jaw should be considered a potential source of infection.

Reports of malignant lymphoma accompanied by silicosis are limited. A 93‐year‐old man with silicosis presented with right massive pleural effusions and was diagnosed with primary pleural lymphoma. Since there was no evidence of chronic pyothorax or Epstein–Barr virus infection, it may be due to silicosis‐associated chronic inflammation.

Medication-related osteonecrosis of the jaw (MRONJ) is reported a rare complication of biological therapy. This report demonstrates that MRONJ can result in sepsis in rheumatoid arthritis patients receiving abatacept and bisphosphonate therapy. Clinicians should be aware of the potential risk and consider it a focus of sepsis in such patients.