He immediately sought treatment at the emergency department of a local hospital and was transferred to a burn intensive care unit (ICU). Within an hour of exposure to the yellow liquid contained in the shell, he developed pain, redness, and blistering from the right hand to the elbow. He handled the undetonated shell without protective equipment and threw the shell back into the water with his right arm. CASE REPORTĪ 40-year-old commercial fisherman with no medical problems was working on a clamming boat 30 miles off the coast when he dredged up a World War I-era artillery shell. 3 Sporadic cases of dredged artillery shells along the Atlantic coast have occurred in recent years, making sulfur mustard exposure a patient presentation of which physicians should be aware. 1, 2 Of these agents, sulfur mustard may be the most hazardous in accidental exposure because of its ability to form a solid or semi-solid material that persists for decades. This practice left an estimated 64 million pounds of nerve and sulfur mustard agents at the bottom of the coastal waters along with countless other chemical agents and undetonated shells. After World War I, World War II, and until 1970, coastal dumping of unwanted munitions, including shells filled with chemical agents, was commonplace. Sulfur mustard, or mustard gas, was a common toxicological exposure among soldiers fighting in World War I, causing severe burns and long-term disfiguration. Sulfur mustard exposure is a rare but devastating injury when discarded artillery shells are encountered in coastal waters. Long-term effects include cosmetic disfigurement and increased risk of developing cancer. Sulfur mustard, or dichlorethylsulphide, is a vesicant chemical warfare agent that causes significant cutaneous chemical burn and is managed with burn wound care. He sustained isolated second degree cutaneous injury requiring wound care and skin grafting. A 40-year-old commercial fisherman presented with a blistering second degree burn to the right arm after handling a dredged and undetonated World War I-era sulfur mustard artillery shell.
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