We report a case of a white  phosphorus burn that has a unique mechanism of injury involving a 40-year-old woman with her 7-year-old daughter who were collecting rocks on a beach in Tel Aviv. Upon returning home, the daughter washed the rocks of sand with tap water and immediately wrapped them in a paper towel. According to her anamnesis, the daughter presented her mother an unusual appearing, yellow translucent colored rock covered by a wet paper towel. As she commenced unwrapping the paper towel, white smoke emanated from the rock that was followed by ignition of flames and accompanied by a severe burning sensation in her hands. Subsequently, she dropped the rock which made contact with her right calf and then landed on her right foot that was covered by a sock and ignited. The patient then proceeded to put out the flames in the bathroom shower. Upon return to the living room, the piece of white  phosphorus had ignited the couch which took hold and the entire apartment was gutted with fire. Both mother and child were safely evacuated from the apartment with no further injuries sustained.
Upon arrival at the Emergency Department, within 1 h of the burn injury, the patient presented as conscious and talking with no evidence of an inhalation injury. Assessment revealed chemical burns from contact with what was suspected to be white  phosphorus. No adequate first aid was administered at the time of the injury. First aid was commenced and the burns underwent decontamination, irrigation and debridement of devitalised tissue. Her wounds were thoroughly irrigated with water and then covered with saline soaked pads and was subsequently admitted to our Burns Center for further treatment.
Digital photography with written informed consent from the patient pertaining to the use for treatment and teaching and learning purposes were taken on admission to the Emergency Department. As this was a retrospective case report the ethics committee of Sheba Medical Center Helsinki Committee does not require ethics approval to be sought for this case report.
Scattered partial thickness burns were sustained on bilateral hands to the dorsum and palms aspects of 0.5% Total Body Surface Area (TBSA), deep dermal burns to her right medial calf of 1% TBSA and full thickness burns were sustained to her right foot dorsum aspect calculated to be 0.5% TBSA (see Fig. 1). Due to the small surface area involvement and our Department's experience with conservative non-surgical approach for minor burn care, the patient's burns were treated with mafenide acetate (Sulfamylon) on the right medial calf and dorsum of foot and Flaminal Forte for the palmar wounds. Vital signs were all within normal limits, bloods were unremarkable and electrocardiogram abnormalities were not observed. 
Throughout the hospitalization period, blood tests were routinely taken twice weekly. The phosphorus level increased gradually from 2.90 mg/dL on day 1 to 4.40 mg/dL on day 14 (normal range 2.5-4.5 mg/dL). C-reactive protein (CRP) levels increased throughout the first 5 days and reached 122.21 mg/L, then gradually decreased to normal parameters (normal range 0-5 mg/L). During the admission period, occupational therapy and physiotherapy were provided to facilitate full range of motion to the hands and right leg. The patient was discharged 22 days after admission and followed up in the outpatient clinic. Pressure garments were provided however; hypertrophic scars began to develop on the dorsum of her right foot. Silicone sheets were provided under the pressure garment and the patient was educated on the importance of adherence to burn care therapy. The patient was again followed up 7 months post injury where digital images were once again obtained with the consent of the patient (see Fig. 2). 
Due to the unusual appearance of the burn in this case report, the patient's clothes were sent for examination to a forensic specialist. Consequently, the police and military investigators confirmed the nature of the chemical agent as white phosphorus crystals to permit preventive measures and announcements were made in the media. It is not known exactly how the piece of white  phosphorus came to be on the beach in Tel Aviv however, the most probable explanations could be that the it may have fallen of a passing cargo ship, migrated from distant industrial factories or power station, remnants from naval training exercises or even an old incendiary bombshell that has been carried away by the sea currents.