Study objective: The acute heavy exposure to sulfur
mustard gas can lead to pulmonary fibrosis (PF). This study was
performed to determine the cellular and protein content of BAL fluid in
24 patients with sulfur mustard gas-induced PF.
Patients: Twenty-four veterans with sulfur mustard
gas-induced PF and 18 nonexposed veterans serving as control subjects
were enrolled into the study.
roentgenograms, pulmonary function tests (PFTs), tests for carbon
monoxide diffusing capacity of the lung (Dlco),
high-resolution CT scans of the chest, BAL via fiberoptic bronchoscopy,
analyses of BAL fluids for cellular and protein constituents, and
determinations of serum albumin and Ig levels were performed in all
cases. A transbronchial lung biopsy was done in all patients following
Results: Neutrophilic alveolitis was the
predominant feature. Neutrophils (p = 0.0001) and eosinophils
(p = 0.0001) were the predominant cell types in the BAL fluid of
patients with PF. There was a strong correlation between the BAL fluid
neutrophil count (ρ = 0.76; p = 0.0003) or its percentage
(ρ = 0.77; p = 0.0003) and the degree of fibrosis. Of the BAL
fluid Ig levels, only the IgG level in the study group was
significantly higher than the IgG level of the control group
(p = 0.0001). Of the PFT physiologic parameters, only the percentage
of Dlco showed a significant correlation with the degree of
fibrosis (ρ = −0.76; p < 0.001).
The cellular constituents of BAL fluid in patients with sulfur mustard
gas-induced PF are very similar to the cellular constituents seen in
patients with idiopathic PF, and this finding indicates the presence of
an ongoing active alveolitis in PF.
Abbreviations: Dlco = carbon monoxide
diffusing capacity of the lung; HRCT = high-resolution CT;
IPF = idiopathic pulmonary fibrosis; PF = pulmonary fibrosis;
PFT = pulmonary function test