Surgical Treatment of Cutaneous Anthrax

A 45-year-old male patient came into contact with a dead cow. Subsequently, a cutaneous rash appeared in his right upper extremity, which gradually increased in size and ulcerated¹. His temperature was elevated up to 40°C. His arm became severely red, swollen, and painful with high tension and high skin temperature. Laboratory tests revealed white blood cell count of 19.88×10⁹/L, 92.5% neutrophils, procalcitonin level of 8.79 ng/mL, and interleukin-6 level of 277.7 pg/mL. The patient had lesion incision and tension reduction, followed by vacuum drainage (Figure 1) and antibiotic therapy with meropenem at another hospital. At our hospital, he received clindamycin and levofloxacin treatments and four weeks of nutritional support. Eventually, the C-reactive protein level, white blood cell count, neutrophil percentage, and temperature returned to normal. The Bacillus anthracis nucleic acid was positive in the wound. After four days of hospital stay, debridement and suture surgery were performed. Triangle-shaped skin necrosis developed after suture removal. A large skin defect formed after debridement.

FIGURE 1:
A patient with cutaneous anthrax was diagnosed with compartment syndrome at another hospital. He had lesion incision, tension reduction, and vacuum drainage. The incised wound can be seen.

(Figure 2). The patient refused to receive a transplanted flap. The wound secretion test was negative for B. anthracis nucleic acid. After one month of dressing treatment, the wound healed.

FIGURE 2:
Triangle-shaped skin necrosis developed after suture removal, and a large skin defect formed after debridement.

(Figure 3). The main treatment for cutaneous anthrax is antibiotics. Compartment syndrome should be treated with fasciotomy^2-3.

FIGURE 3:
The wound healed well after one month of dressing treatment.

ACKNOWLEDGMENTS

The authors give special thanks to the Department of Orthopedics staff.

REFERENCES

• ¹
  Gilliland G, Starks V, Vrcek I, Gilliland C. Periorbital cellulitis due to cutaneous anthrax. Int Ophthalmol. 2015;35(6):843-5.
• ²
  Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT, et al. Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20(2).
• ³
  Knox D, Murray G, Millar M, Hamilton D, Connor M, Ferdinand RD, et al. Subcutaneous anthrax in three intravenous drug users: a new clinical diagnosis. J Bone Joint Surg Br. 2011;93(3):414-7.

Publication Dates

• Publication in this collection
  20 Dec 2019
• Date of issue
  2020

History

• Received
  02 Feb 2019
• Accepted
  08 May 2019