Diagnosis
The differential diagnosis based on the imaging findings included ossification of subperiosteal hematomas, ectopic calcification in the setting of a connective tissue disorder, and periostitis deformans secondary to fluoride intoxication. Laboratory assays were requested by the patient’s rheumatologist, which were notable for a mildly elevated alkaline phosphatase level (216 U/L, reference range=40–115 U/L) and a markedly elevated serum fluoride level (3.9 mg/L, normal range <
Tea drinking remains popular in the United States and increasingly is suggested to promote health. We caution that skeletal fluorosis can result from consumption of excessive amounts of instant tea because of substantial fluoride levels in some commercial preparations.
Case report
A 52-year-old white woman consulted in 1998 for dense lumbar vertebras discovered after twisting her back. Spinal discomfort and stiffness for 5 years reflected “disc disease.” She had never had a fracture. Chest
All cases of chronic fluoride intoxication with radiculomyelopathy have been previously reported from India (1, 2). This paper describes a patient with clinical, necropsy, and toxicologic findings of this disorder, whose problem is of special interest because he lived in an area where cases of advanced fluorosis would not be expected.
CASE REPORT
A 64-year-old white male was admitted to the Veterans Administration Hospital, McKinney, Tex., on May 11, 1962, because of severe respiratory d
About the Authors:
William J Johnson, director of the Mayo Artificial Kidney Center and professor of medicine with the Division of Nephrology at the Mayo Clinic, has been involved in the study of calcium and phosphorus metabolism and renal osteodystrophy, potassium metabolism, and uremic neuropathy. He is past chairman of the Minnesota State Medical Association’s Committee on Dialysis and Transplantation and served on the editorial board of Nephron. He has published over 70 papers in his fiel
CASE DESCRIPTION
A 45-year-old white male was found to have radiographic findings of a diffusely dense appendicular skeleton, mild trabecular thickening, and multiple thoracic compression fractures indicating structural weakness. Bone mineral density was above the expected range for his age on the lumbar spine and femoral neck. Social history was significant for well-water consumption and daily instant-tea ingestion of 68 oz (1.89 L) for the past 10–15 years. Pertinent laboratory data are pre
Kurland et al.(1) reported a fascinating case of skeletal fluorosis in a man who probably ingested significant quantities of fluoride from toothpaste. They report that after withdrawal of fluoride, there was a short initial period of rapid bone loss, followed by a prolonged period of slow BMD loss from the lumbar spine—such that the Z-score was still +9 some 8 yr later.
A patient with skeletal fluorosis has attended my clinic for a similar period. At the age of 53 yr, after having sustained
