Skeletal Fluorosis: An Unusual Manifestation of Computer Cleaner Inhalant Abuse

Area of Science:

• Toxicology
• Endocrinology
• Bone Metabolism

Background:

• Skeletal fluorosis is a metabolic bone disease caused by fluoride accumulation, typically linked to contaminated groundwater in developing nations.
• While not a common public health concern in the US, skeletal fluorosis can arise from chronic recreational or occupational exposures.
• This case report focuses on a rare instance of skeletal fluorosis in the United States.

Observation:

• A 33-year-old male patient presented with hyperkalemia and acute kidney injury, complicated by NSAID and antihypertensive use.
• Anemia, elevated alkaline phosphatase, and diffuse bone density increases on imaging were noted.
• The patient had a history of major depressive disorder, substance abuse, and computer cleaner inhalant abuse.

Findings:

• Hematologic evaluation, including bone marrow biopsy, showed diffuse sclerosis.
• Elevated urinary fluoride levels, coupled with inhalant abuse history, supported the diagnosis of skeletal fluorosis.
• Serum fluoride levels were within normal limits, underscoring the diagnostic challenge.

Implications:

• This case underscores the importance of considering skeletal fluorosis in patients with non-specific bone abnormalities and a history of inhalant abuse.
• Diagnosing skeletal fluorosis in the US requires a high index of suspicion and thorough patient history.
• Awareness of this rare condition is crucial for clinicians to ensure timely and accurate diagnosis.