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Delayed head and neck complications of sulphur mustard poisoning in Iranian veterans

Published online by Cambridge University Press:  02 July 2009

R Zojaji ,
M Balali-Mood ,
M Mirzadeh ,
A Saffari  and
M Maleki
R Zojaji*
Affiliation:
Department of Otolaryngology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
M Balali-Mood
Affiliation:
Department of Medicine, Medical school, Medical Toxicology Research Centre, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
M Mirzadeh
Affiliation:
Department of Paediatrics and Internal Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
A Saffari
Affiliation:
Department of Paediatrics and Internal Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
M Maleki
Affiliation:
Department of Dermatology, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
*
Address for correspondence: Dr Ramin Zojaji, 5, 10th Hashemieh, Hashemieh Blvd, Mashhad, Iran, 9178648451. Fax: 0098 511 8828979 E-mail: raminzojaji@yahoo.com
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Abstract

Objective:

Sulphur mustard is a chemical warfare agent which was used against Iranian combatants and civilians between 1983 and 1988. The purpose of this study was to document the delayed toxic effects of sulphur mustard in Iranian veterans, focussing on head and neck complications.

Patients and methods:

This was a two-year, prospective, descriptive study of 43 male Iranian veterans aged 34 to 48 years (mean 41.8 years) who were moderately disabled or worse due to sulphur mustard poisoning. Investigations were performed with consent, including haematological, biochemical and immunological tests, spirometry, chest X-ray, high resolution computed tomography of the lungs, and skin biopsies. Further investigations and interventions were performed as clinically indicated.

Results:

The most affected sites were the lungs (95 per cent), peripheral nerves (77 per cent), skin (73 per cent), eyes (68 per cent), and head and neck (16.2 per cent). Of seven patients with mostly head and neck complications, four had a skin disorder (hyperpigmentation in all four, an erythematous, papular rash in two, and dry skin in one). Two patients had thyroid cancer (undifferentiated thyroid carcinoma in one and papillary carcinoma of a thyroglossal cyst in the other, 12 and 14 years after sulphur mustard exposure, respectively). One patient had nasopharyngeal carcinoma, 12 years after sulphur mustard exposure.

Conclusion:

Carcinomas of the thyroid and nasopharynx in three patients with sulphur mustard exposure are reported for the first time.

Keywords

Chemical Warfare AgentSulphur MustardThyroglossal CystCancerHead And Neck
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 10 , October 2009 , pp. 1150 - 1154
Copyright
Copyright © JLO (1984) Limited 2009

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