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


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.


CONCLUSIONS
Carcinomas of the thyroid and nasopharynx in three patients with sulphur mustard exposure are reported for the first time.
Zojaji
R
R
Department of Otolaryngology, Mashhad Branch, Islamic Azad University, Mashhad, Iran. raminzojaji@yahoo.com
Balali-Mood
M
M
Mirzadeh
M
M
Saffari
A
A
Maleki
M
M
D000328:Adult; D002277:Carcinoma / Q000139:chemically induced*; D002619:Chemical Warfare Agents / Q000506:poisoning*; D006258:Head and Neck Neoplasms / Q000139:chemically induced*; D006801:Humans; D019570:Inhalation Exposure; D007492:Iran; D008297:Male; D008875:Middle Aged; D009151:Mustard Gas / Q000506:poisoning*; D011446:Prospective Studies; D012871:Skin Diseases / Q000139:chemically induced*; D013997:Time Factors; D014728:Veterans
D002619:Chemical Warfare Agents; D009151:Mustard Gas