Emergency airway management in a patient with a Montgomery T-tube in situ.

other sources of fluorine exposure. Epicutaneous tests made 6 months after the episode were negative. Because colchicine is thought to be antineutrophilic, treatment with colchicine was started. The half-life of excretion of inorganic fluoride from sevoflurane biodegradation is 2–4 days. Treatment with colchicine and topical corticosteroids was followed by resolution of the skin lesions within 7 days during hospitalization. There was no recurrence after discontinuation of treatment with colchicines during the following year. A plasma inorganic fluoride concentration of 50 mmol litre was previously associated with nephrotoxicity with methoxyflurane and was defined as the upper normal range. Fluoride is excreted primarily via the urine. Accumulation of fluoride is rare, but the cytochrome P450 system could not be explored in this patient. No specific source of fluoride was found, but other sources including natural fluoride in foodstuffs and water (fluoridated water, fluoride supplements, fluoride dentifrices, and professionally applied fluoride gel) could not be easily detected. 6 The main source of fluoride for humans is the intake of groundwater contaminated by geological sources. Fluoroderma (a halogenoderma) is a rare cutaneous hypersensitivity reaction to fluorine exposure. Patients typically present with exudative plaques, fungating nodules, necrotic ulcers, and acneiform eruptions. Histological analysis reveals papillomatosis and accumulation of neutrophils in the dermis (without vasculitis). Treatment includes avoidance of the source of fluorine, wound care, and the administration of topical or systemic corticosteroids. To increase renal excretion of fluorine, diuretics and sodium chloride can be used. Although our patient appeared to have a good response to colchicine treatment, we are unable to rule out spontaneous resolution due to the excretion of inorganic fluoride. Fluorine intoxication from ingestion or dental care has been described, but we are unaware of other reports of fluoroderma caused by sevoflurane. Most reported cases of halogenoderma have occurred after exposure to bromide and iodide. 10 In some studies, lymphocyte transformation tests were positive to iodinated proteins, suggesting a mechanism of hypersensitivity. The main hypothesis was that biotransformation of sevoflurane has exacerbated a chronic exposure to fluoride. Millions of general anaesthesia are given each year around the world with sevoflurane. Physicians should be aware that fluoroderma is a rare, dose-related but life-threatening potential complication of sevoflurane. Colchicine seems to be an adequate treatment.