Document Type : Original Research


1 Dept. of Forensic Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Forensic and Legal Medicine Organization, Tehran, Iran

3 Dept. of Pediatrics, Kashan University of Medical Sciences, Kashan, Iran

4 Dept. of Internal Medicine, Iran University of Medical Sciences, Tehran, Iran


Background & Objectives: Respiratory, central nervous system, and skin complications of mustard gas toxicity have previously been studied; however, the liver and kidney side effects due to this intoxication have not been fully noted. We aimed to evaluate the frequency of liver, kidney and lung lesions in mustard gas-exposed Iranian veterans who had been exposed to the toxin almost 2 decades before.
Methods: A total of 100 veteran bodies underwent autopsy by at least two forensic medicine specialists. The liver, kidney and lung specimens were sent for pathological examination and their lesions, severity of the lesions, and the relation between the type/severity of the lesions and the time elapsed since their appearance were studied.
Results: A total of 83%, 63%, and 62% of the veterans had lung, liver, and kidney pathologies. The most common pathologies included liver steatosis, interstitial fibrosis of the kidney, and lung atelectasis.
Conclusion: Liver and kidney pathologies are far more common than what is considered in the mustard gas-exposed veterans. These pathologies are often accompanied by very severe lung complications.


  1. Evison D, Hinsley D, Rice P. Chemical weapons. BMJ 2002; 324(7333):332-5. 
  2. Bullman T, Kang H. A fifty year mortality follow-up study of veterans exposed to low level chemical warfare agent, mustard Gas. Ann Epidemiol 2000; 10:333-8.
  3. Momeni AZ, Enshaeih S, Meghdadi M, Amindjavaheri M. Skin manifestations of mustard gas. A clinical study of 535 patients exposed to mustard gas. Arch Dermatol 1992;128:775-80.
  4. Balali-Mood M, Hefazi M. The pharmacology, toxicology, and medical treatment of sulphur mustard poisoning. Fundam Clin Pharmacol 2005;19:297-315.
  5. Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol 2006;99:273-82.
  6. Emad A, Emad V. Elevated levels of MCP-1, MIP-alpha and MIP-1 beta in the bronchoalveolar lavage (BAL) fluid of patients with mustard gas-induced pulmonary fibrosis. Toxicology 2007;240:60-9.
  7. Emad A, Emad Y. Increased granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) levels in BAL fluid from patients with sulfur mustard gas-induced pulmonary fibrosis. J Aerosol Med 2007;20:352-60.
  8. Zamani N. Pirfenidone; can it be a new horizon for the treatment of pulmonary fibrosis in mustard gas-intoxicated patients? Daru 2013;21(1):13.
  9. Namazi S, Niknahad H, Razmkhah H. Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans. J Med Toxicol 2009;5:191-5.
  10. Emad A, Rezaian GR. Immunoglobulins and cellular constituents of the BAL fluid of patients with sulfur mustard gas-induced pulmonary fibrosis. Chest 1999;115:1346-51.
  11. Emad A, Rezaian GR. Characteristics of bronchoalveolar lavage fluid in patients with sulfur mustard gas-induced asthma or chronic bronchitis. Am J Med 1999;106:625-8.
  12. Mahmoudi M, Hefazi M, Rastin M, Balali-Mood M. Long-term hematological and immunological complications of sulfur mustard poisoning in Iranian veterans. Int Immunopharmacol 2005;5:1479-85.
  13. Ghanei M, Naderi M, Kosar AM, Harandi AA, Hopkinson NS, Poursaleh Z. Long-term pulmonary complications of chemical warfare agent exposure in Iraqi Kurdish civilians. Inhal Toxicol 2010;22:719-24.