Long-term pulmonary complications of chemical weapons exposure in former poison gas factory workers.
Sulfur mustard (SM) and lewisite are vesicant chemical warfare agents that can cause skin blistering and chronic lung complications. During 1929-1945, a Japanese factory produced poisonous gases, which included SM, lewisite and other chemical weapons. The aim of this study was to investigate the chest computed tomography (CT) findings among long-term survivors who worked at this factory.



During 2009-2012, we evaluated chest CT findings from 346 long-term survivors who worked at the poison gas factory. Skin lesions were used as an indicator of significant exposure to vesicant agents.



Among the 346 individuals, 53 (15%) individuals experienced skin lesions while working at the factory, and chest CT revealed abnormal findings in 179 individuals (52%). Emphysema was the most common CT finding and was observed in 75 individuals (22%), while honeycombing was observed in 8 individuals (2%). Emphysema and honeycombing were more prevalent among individuals with skin lesions, compared to individuals without skin lesions. Multivariate analyses revealed significant associations between the presence of emphysema and skin lesions (p = 0.008). Among individuals who never smoked, individuals with skin lesions (n = 26) exhibited a significantly higher rate of emphysema, compared to individuals without skin lesions (n = 200) (35% versus 7%, respectively; p < 0.001).



Among the long-term survivors who worked at the poison gas factory, a history of skin lesions was associated with the presence of emphysema, even among never smokers, which suggests that emphysema might be a long-term complication of exposure to chemical warfare agents.
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .|b Tadanoumi Hospital , Takehara , Japan .
Yoshifumi
Y
Nishimura
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .
Hiroshi
H
Iwamoto
c Department of Internal Medicine , Hiroshima Prefectural Hospital , Hiroshima , Japan .
Nobuhisa
N
Ishikawa
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .
Noboru
N
Hattori
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .
Yasushi
Y
Horimasu
d Department of Emergency and Critical Care Medicine , Graduate School of Biomedical Sciences, Hiroshima University , Hiroshima , Japan .
Shinichiro
S
Ohshimo
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .
Kazunori
K
Fujitaka
b Tadanoumi Hospital , Takehara , Japan .
Keiichi
K
Kondo
e Department of Physical Analysis and Therapeutic Sciences , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan , and.
Hironobu
H
Hamada
f Department of Diagnostic Radiology , Institute of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan.
Kazuo
K
Awai
a Department of Molecular and Internal Medicine , Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima , Japan .
Nobuoki
N
Kohno
D000368:Aged; D000369:Aged, 80 and over; D001152:Arsenicals / Q000009:adverse effects*; D002617:Chemical Industry; D002619:Chemical Warfare Agents / Q000633:toxicity*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects; D008297:Male; D009151:Mustard Gas / Q000633:toxicity*; D009784:Occupational Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects*; D011656:Pulmonary Emphysema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012871:Skin Diseases / Q000139:chemically induced; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
D001152:Arsenicals; D002619:Chemical Warfare Agents; C035965:lewisite; D009151:Mustard Gas
Chemical warfare; respiratory disorder; skin injury; sulfur mustard