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Anthrax, Cutaneous


Step 1: View clinicals

A 48 year old cattle farmer presents with multiple painless black lesions on his right arm. Two weeks ago he had accidentally grazed his right arm on a farm tool. A few days later, pruritic papules appeared at that sites. These subsequently progressed into larger lesions surrounded by edema, over the following weeks. His medical, surgical and drug histories are unremarkable. He does not smoke or consume alcohol, and denies abuse of prescription drugs.

Step 2: Order all relevant investigations

Skin Lesion Culture + Gram Stain

The gram stain reveals large, square-ended, gram-positive rods growing in chains, containing oval, central to subterminal spores. After 24h, cultures reveal dull, flat, white-grey non-hemolytic colonies, consistent with Bacillus anthracis.

Nasopharyngeal Cultures

Gram stain: Normal upper respiratory flora Culture results will be available in 3 days.

Lumbar Puncture

Appearance: clear Polymorphs: nil (< 5) Gram stain: negative Glucose: 70 mg/dL (50 - 80) Protein: 50 mg/dL (15 - 60)

Blood Culture

Culture results will be available in 3 days.

Step 3: Select appropriate management

Oral doxycycline
Topical antibiotics
Dry dressings

Score: ★★☆