Mustard pulmonary toxicity

These drugs were developed from mustard gas used during the First World War. In addition to bone marrow suppression they cause pulmonary toxicity, that can lead to fibrosis and death. The fibrosis, which is not reversible, can be detected by pulmonary function studies, which should be included in the pre-operative evaluation of patients receiving these drugs. 

Chlorambucil, melphalan, and uracil mustard also have been associated with pulmonary fibrosis. Of the alkylating agents, only nitrogen mustard and thiotepa have not been reported to cause fibrotic pulmonary toxicity. ... 

Pediatric exposures to vesicants can be quite toxic however, in contrast to nerve agent exposures, HD causes significantly greater morbidity than mortality. While mustard did not cause many deaths in WWI, death from HD exposure is usually due to massive pulmonary damage complicated by infection (bronchopneumonia) and sepsis. Children often show a quicker onset and greater severity of toxicity. Skin and eye toxicity occurs in the form of blisters or irritation that can result in blindness for the most severe cases. Except for lewisite, vesicant exposures must be managed with supportive care and rapid decontamination. 

Weinberger, B., Laskin, J.D., Sunil, V.R., Sinko, P.J., Heck, D.E., Laskin, D.L. (2011). Sulfur mustard-induced pulmonary injury therapeutic approaches to mitigating toxicity. Pulm Pharmacol Ther., Vol. 24, No. 1, (Feb. 2011), pp. 92-99 ISSN 1094-5539 Wenzel, H.R. and Tschesche, H. (1995). Reversible inhibitors of serine proteinases. In Peptides Synthesis, Structures, and Applications, Ed. B. Gutte, pp. 321-362, Academic Press, ISBN 0123109205, USA... 

Weinberger, B., Laskin, J.D., Sunil, V.R., et al., 2011. Sulfur mustard-induced pulmonary injury therapeutic approaches to mitigating toxicity. Pulm. 

SM causes injury via four major routes (i) skin damage after absorption through the integument (ii) eye damage after exposure to mustard gas vapor (iii) broncho-pulmonary effects after inhalation and (iv) systemie toxicity after ingestion or absorption of high amounts of SM. ... 

Also possible toxic pulmonary oedema with type 1 respiratory failure if a dust vector impregnated with mustard agent has been used... 

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