A rare presentation of anthrax with sepsis: A case report

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 the 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 who had positive blood and wound cultures and were complicated with sepsis are presented. A 39-years-old male patient living in Kars (Eastern Turkey) was admitted with systemic fever, chills,and a wound with swelling redness 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 2-3 cm centrally necrotic and peripherally edematous wound confined to the right forehand. 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 the 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 the 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. MLVA method with 25 loci was used for genotyping, and it was determined that the genotype in our case is GK43 that is located in the major cluster A and subset 3. On the tenth day of hospitalization due to the widespread and necrotic lesions on his arm , compartment syndrome had been occurred. Escharatomy had been established for the treatment of comparment syndrome. After three weeks of antibiotherapy, the patient has been discharged from the hospital with good health.As a conclusion, this case report reminds need of high attention to the clinical course of cutaneous anthrax in order to avoid severe complications such as sepsis