Skeletal Fluorosis: A Case Report of Rare Diagnosis of Computer-cleaner Toxicosis

Introduction: Skeletal fluorosis is a complication of excess fluoride which may be associated with chronic inhalation or “huffing” of compressed air cleaners for keyboards and electronics. The rare presentation of this condition can lead to a missed diagnosis and lack of appropriate intervention. Clinicians should be aware of the potential development of fluorosis in patients reporting a history of inhalant abuse. Case Report: We present a case of skeletal fluorosis in a patient with a 4-month history of daily inhalant abuse of computer cleaner containing difluoroethane (DFE). She presented to the emergency department after developing myalgias for approximately 4 months and noted to have diffuse bilateral swelling to upper and lower extremities, as well as interphalangeal joint swelling and non-mobile lesions to bilateral hands and left forearm on physical exam. Radiography revealed diffuse periosteal reaction throughout the hand and forearm suggestive of fluorosis. She was counseled to cease inhalant use and endorsed pain was alleviated by rest, heat therapy, and pain medication. Conclusion: Skeletal fluorosis is a rare and painful condition, which can have prolonged adverse effects and lasting impacts on quality of life. Patients who report regular inhalant use should be counseled on the potential toxicities of these products and encouraged to cease use. Those presenting with diffuse skeletal findings and reported DFE use should be evaluated for skeletal fluorosis.