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
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Skin Blistering: due to its vesicant properties
- Mucous Membrane Irritation
- Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
- Pathology: diffuse alveolar damage
- Residual Tracheobronchitis
- Reactive Airway Dysfunction Syndrome (see Reactive Airway Dysfunction Syndrome, [[Reactive Airway Dysfunction Syndrome]])
- Bronchiectasis (see Bronchiectasis, [[Bronchiectasis]])
- Bronchotracheomalacia (see Tracheomalacia, [[Tracheomalacia]])
- Pulmonary Fibrosis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])
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 IFNγ 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]