Bioanalytical verification of sulfur mustard exposure in a syrian family

Sulfur mustard (CAS No. 505-60-2) which is defined as a “Schedule I chemical” in the Chemical Weapon Convention is a vesicant chemical warfare agent (CWA) (1). Sulfur mustard (SM) was first synthesized in 1822 by a Belgian Chemist, Cesar Despretz and the chemical formula was modified with a twostage synthesis process by a German Chemist, Victor Meyer in 1886 (2). SM was the first vesicant CWA which was used by Germans against Allied Forces in Ypres, Belgium on July 12, 1917 (3). Due to its devastating acute and chronic effects, SM was called as “King of Battle Gases” in World War I (2). SM was used in large scales by Iraq armed forces during the Iran-Iraq War between 1980 and 1988 (4). SM has a characteristics odor of mustard or horse radish and it is absorbed rapidly by inhalation, dermal contact, or from the anterior surface of the eye (5). It is a highly reactive compound which has carcinogenic and cytotoxic effects (2, 6). SM is also called as “radiomimetic drug” as effects of systemic SM poisoning are similar to chemotherapeutic agents (7). Except the literature which was related with chemical casualties of the Iran-Iraq War, chemical terrorist attacks against civilians in Middle East, accidental contact with old chemical munitions, and occupational accidents are the context of the recent literature about the clinical presentation of SM exposure (8, 9, 10). The hallmark of the exposure is asymptomatic latency period which is typical for SM poisoning (7, 11).