Akademik Veri Yönetim Sistemi
The Journal of emergency medicine, cilt.52, sa.2, ss.240-241, 2017 (SCI-Expanded)
CASE REPORTS
Case 1
A 34-year-old woman presented to the Emergency
Department (ED) with complaints of sores and swelling
in the right forearm for a week. The initial lesion was
like an itchy insect bite; however, it progressed into a
swelling in the forearm within a week. Diffuse subcutaneous
edema started from the elbow, extending to the distal
right upper extremity with black bullae at the dorsum of
the right hand (Figure 1A and B).
Case 2
A 33-year-old woman presented 2 days after the first case
with the complaint of sores in the right hand. The complaints
of the patient had developed within 2 days and
progressively spread. The patient had black excoriated
bulla and edema at the dorsum of the right hand
(Figure 1C and D). These patients performed the butchering
of a cow together.
DISCUSSION
Anthrax is a zoonotic infection caused by spores of
Bacillus anthracis, which is a Gram-positive rod (1).
Transmission of the disease, from animal to human,
occurs via direct contact (cutaneous anthrax, 95%),
ingestion of infected raw meat (gastrointestinal anthrax),
or inhalation (pulmonary anthrax) during slaughtering or
processing the animal products (2). Cutaneous anthrax
usually presents as a pruritic painless papule resembling
an insect bite. Later, the papule broadens and becomes
an ulcerated lesion circled with vesicles. The characteristically
black necrotic scar occurs in the center of the
lesion, in association with edema and bacterial toxin
(3). Cutaneous anthrax is sensitive to intravenous penicillin
G treatment for 7–14 days. Both patients were discharged
with cure after 6 days of hospitalization. In
conclusion, in patients who have skin lesions such as pruritic
painless papule, black excoriated bulla and edema, or
black necrotic scar occurring in the center of the lesion,
emergency physicians should consider cutaneous
anthrax. Early administration of oral or intravenous penicillin
is necessary