Clinical Practice and Cases in Emergency Medicine

Case Presentation: A 60-year-old male from the country of Jordan presented to the emergency department with swelling, pain, black lesions on his fingertips and thumb, and a red streak up his arm. The patient had been trimming sheep wool and goat skin two weeks prior to onset of symptoms and cut his left thumb with trimming shears. 

Discussion: Cutaneous anthrax is caused by Bacillus anthracis, a Gram-positive, spore-forming rod found naturally in the soil. Populations at greatest risk include those who consume undercooked meat with contaminated spores or who live and work in rural/agricultural areas. Occupations considered to be at a higher risk include farmers, wool sorters, and veterinarians. Although cutaneous anthrax is rare in the United States (U.S.), there have been cases reported since the bioterrorism attacks in 2001 when mail laced with anthrax was sent via the U.S. Postal Service. Human infection occurs in countries where the disease is endemic in livestock. Because there are no rapidly available diagnostic tests the diagnosis is primarily clinical. It is important to consider the possibility of cutaneous anthrax in the appropriate setting, despite the rarity of cases in the U.S. High clinical suspicion should be maintained in anyone presenting with the appropriate skin findings, especially in those traveling from endemic countries (South and Central Asia, Sub-Saharan Africa, Southern and Eastern Europe, Central America, South America, and the Caribbean).