Anthrax is a zoonotic infection caused by Bacillus anthracis.
Although the incidence of the disease is decreasing in our country,
it is still endemic in certain regions of the country. The cutaneous
form of disease is the most common clinical form, which is usually
benign and rarely causes bacteriemia and sepsis. In this case report,
a cutaneous anthrax case with positive blood and wound samples
that complicated with sepsis is presented. A 39-years-old male
patient living in Kars (Eastern Turkey) admitted with systemic
fever, chills and a local hyperemic wound on the right arm. In his
medical history the patient stated an insect (fly) bite three days
ago and consequent development of a lesion on his right arm. He
also stated that he had slaughtered a lamb 10 days ago by himself.
On admission the patient was detected to have a 3-4 cm centrally
necrotic and peripherally edematous wound confined to right
forehand (Figure 1).
Figure 1: The patient’s skin lesions on admission.
Figure 2: The patient’s lesions on the second day of treatment.
There was also fever, hyperemia and general edema confined to
right arm up to the shoulder level. With the preliminary diagnosis
of cutaneous anthrax, the patient was hospitalized and ampicillin
sulbactam therapy was started but due to progression of the lesion
and clinical deterioration the treatment was changed to piperacillin
tazobactam and clindamycin. The swab samples from the wound
were sent to laboratory and revealed gram positive sporulated
bacilli and following blood cultures were also positive for growth.
The agent pathogen was identified as B. anthracis by gram stains
from wound samples and blood cultures which was susceptible
to penicillin. Due to poor clinical course, widespread and necrotic
lesions on his arm the patient was sent to an upper medical center.
As a conclusion this case report reminds need of high attention
to clinical course of cutaneous anthrax in order to avoid severe
complications such as sepsis (Figure 2).