48 y/o M presents after dredging for clams off the coast of Long Island. He reports finding a metallic object in his net, then throwing it overboard. Over the next two hours he develops the following….

What’s the diagnosis?

Sulfur mustard exposure

Before the 1970s, the United States Army dumped of thousands of WWI era munitions off the East Coast of the United States.

Sulfur mustard is a vesicant that causes delayed burns to the eyes, skin, and respiratory tract. It appears as an oily liquid ranging in color from colorless to yellow or brown. It was used in the Iran-Iraq war. Symptoms typically appear within a few hours of exposure.

Treatment consists of decontamination with copious amounts of soap and water. There is no specific antidote for sulfur mustard. Treatment should focus on symptom management, supportive care, toxicology and CDC consultation, and transfer to a burn center when appropriate.