Friday, May 16, 2008

Friday May 16, 2008

Q: 52 year old male, who recently travelled, having charity work at rural africa, presented with shortness of breath. Following CXR was obtained. On examination, patient noticed to have 'painless' ucerated lesions over skin.









With travel history, widened mediastinum and ulcerated cutaneous ulcer. What is your biggest concern?



A; Anthrax

Anthrax is primarily a disease of livestock, such as sheep, cattle, or goats, and most cases occur in developing countries. But lately it found fame as a potential agent of bio-terrorism.

Progressive widened mediastinum is one hallmark of anthrax infection. Inhalational anthrax presents as hemorrhagic mediastinitis, not pneumonia, which may be associated with bloody pleural effusions.

Cutaneous anthrax (skin manifestation) is most common and begins as a pruritic papule that enlarges in 24-48 hours to form an ulcer surrounded by edematous halo. The cutaneous anthrax ulcer is usually pruritic but not painful.

Penicillin, Doxycycline or any Quinolone is the treatment.


See concise ppt presentation on Anthrax
here (from Suzanne R. White, M.D., Departments of Emergency Medicine & Pediatrics, Wayne State University, Detroit Medical Center, Michigan)