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What is the diagnosis?

Answer for the medical quiz – 50-years-old male pains in the limbs

Elucidation

Fluorosis is a public health problem and Telangana State is one of the endemic areas. When excess of fluoride is consumed by ingestion, inhalation or medication, fluoroapatite crystals are deposited in soft tissue and bones. The findings in the quiz case include diffuse sclerosis of the bones of the forearm with mineralisation of the intraosseous membrane. These findings may also be found in renal osteodystrophy, X-linked hypophosphatemia, osteogenesis imperfecta type V, osteopetrosis, Paget and seronegative spondyloarthropathies. When a patient presents with musculoskeletal symptoms and is from endemic area, fluorosis should be considered. Radiological findings of the skeleton may be seen from head to toe. However, since diffuse sclerosis can be encountered in many disorders, mineralisation of the intraosseous membrane of the forearm associated with sclerosis of bones and enthesopathy gives a clue to the diagnosis of fluorosis.

Further reading

Kakarla S. Musculoskeletal fluorosis – imaging spectrum. J Med Sci Res 2013; 1(3): 117-123.