Sulfur Mustard Gas

Physiology

  • Wartime Exposure to Sulfur Mustard Gas
    • Sulfur mustard gas is the only World War I-era chemical weapon that has been used miltarily since World War II
    • Exposure during Iran war: in veterans and refugees

Physiology

  • Sulfur Mustard Gas Inhalation

Diagnosis

  • FOB: may be necessary to rule out airway injury

Clinical Manifestations

Pulmonary Manifestations

Bronchiolitis Obliterans (BO) (see Bronchiolitis Obliterans, [[Bronchiolitis Obliterans]])

  • Epidemiology
    • Reports of sulfur mustard-associated BO date back to World War I (1914-1918) and the Iran-Iraq War (1980-1988), during which this agent was used
  • Clinical: acute chemical pneumonitis (chest tightness, dyspnea, massive hemoptysis) -> fibrous exudates and granulation tissue in bronchi/distal bronchioles -> eventual development of bronchiolitis obliterans

Other Manifestations


Treatment

  • Corticosteroids (see Corticosteroids, [[Corticosteroids]]): may be beneficial in acute lung injury, but unproven

References

  • Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. Eur J Radiol 2004;52:164-9 [MEDLINE]
  • Inhaled corticosteroids and long-acting beta 2-agonists in treatment of patients with chronic bronchiolitis following exposure to sulfur mustard. Inhal Toxicol 2007;19:889-94 [MEDLINE]
  • Therapeutics effect of N-acetyl cysteine on mustard gas exposed patients: evaluating clinical aspect in patients with impaired pulmonary function test. Respir Med 2008;102:443-8 [MEDLINE]
  • Sulfur mustard-induced pulmonary injury: therapeutic approaches to mitigating toxicity. Pulm Pharmacol Ther 2011;24:92-9 [MEDLINE]
  • Effect of recombinant human IFN╬│ in the treatment of chronic pulmonary complications due to sulfur mustard intoxication. J Immunotoxicol 2014;11:72-7 [MEDLINE]
  • The role of N-acetylcysteine in the management of acute and chronic pulmonary complications of sulfur mustard: a literature review. Inhal Toxicol. 2014 Aug;26(9):507-23. doi: 10.3109/08958378.2014.920439 [MEDLINE]