A 70 years old farmer from Yemen was referred as a case of osteoarthritis of both knees for preoperative rehabilitation procedures. Six years before he developed progressive skeletal stiffness. By 70 years he became dependent for ambulation and many other self-care activities.
He showed quadriparesis resulting from compression of spinal cord and nerve roots at multiple levels associated with multiple joint involvement. Electrodiagnosis: Needle EMG showed chronic neurogenic changes of motor unit potentials at different levels especially in the proximal muscles of the upper limbs. Evoked potential studies revealed absence or delayed SEPs on stimulation of both Median and Tibial nerves. Total myelography showed multiple indentation of the contrast column. Plain X-rays of pelvis, dorso-lumbar spines and the right forearm showed uniform increase in bone density with calcification of interosseous membrane and ligaments. Fluoride levels in the water sample from Yemen and the patient’s urine were elevated. Apart from Macrocytic Anaemia, all other haematological and biochemical investigations were normal. Discussion: The fluoride level in the water sample from Yemen was relatively low when compared to the standards put down by the WHO and many other authors to cause a crippling skeletal fluorosis. The disability in this case could be due to drinking large amounts of contaminated water for decades and working under the sun. Electrophysiological study was useful in confirming the diagnosis which showed features of upper and lower neurone lesion.