THE CLINICAL TOXICOLOGY OF SULFUR MUSTARD

Sulfur mustard (SM) or mustard gas is one of the most important agents of chemical warfare due to its simple and cheap chemical synthesis that makes it readily available for both military and terrorist use. SM acts as an alkylating agent that induces disruption of nucleic acids and proteins, impairing cell homeostasis and eventually causing cell death. It rapidly reacts with ocular, respiratory, and cutaneous tissues, as well as bone marrow and the mucosal cells of the gastrointestinal tract, resulting in several devastating long-term effects on human health, many of which are not clinically nor pathologically well defined. In light of the possible threat of SM use against military and civilian populations, physicians should be aware of its grave effects and know how to care for its victims. The pattern of immediate and long-term toxic effects following exposure to SM is reviewed with special references to the recent data on clinical and paraclinical investigations and management of more than 100,000 chemical war casualties incurred during the Iran-Iraq conflict.