Skeletal Fluorosis only diagnosed after death

A 64-year-old Texan man repeatedly sought medical help in the last 14 years of his life to address his bone pain and urinary tract problems. In his first visit, the man — who at the time had “moderate kyphosis” (pokerback) — “complained of pain and cramping in the left leg and of weakness and stiffness of all limbs for several years.” He described polyuria (excessive urination) and polydipsia (excessive thirst) of 20 years duration. X-rays revealed “increased size and density” of his long bones and spine, and spinal cord compression from “calcification of the paravertebral ligaments and calcification of sacrospinous ligaments.” The doctors, who unsuccessfully attempted to undo the cord compression, diagnosed the man as having “amyotrophic lateral sclerosis.” Four years later, the man was readmitted to the hospital due to epididymitis and urinary problems. Upon examination, the doctors found that “the neurological signs of spastic quadraparesis had increased,” that the man’s muscles were wasting, and that his bone density was continuing to increase. The doctors were unable to determine the basis for the bone changes, nor were they able to do so during three additional readmissions over the next 7 years. By the time of the man’s sixth and final admission, he had become a “complete invalid” and was “critically ill with pneumonia and shock.” He died shortly after admission. After his death, a bone biopsy revealed a high fluoride content (6,100 ppm). Thus, after six hospitalizations spanning fourteen years, the doctors finally diagnosed the (then deceased) man’s disease as crippling skeletal fluorosis.