Probable case of cutaneous anthrax with toxic manifestations and fatality seen in an adolescent in Sokoto, Nigeria: A postmortem review

Abstract

Background: Anthrax is a life-threatening zoonotic disease caused by Gram-positive, spore-forming bacterium Bacillus
anthracis. It manifests as a cutaneous, gastrointestinal, and respiratory disease. The cutaneous form ranges from a self-limiting
lesion to severe edematous lesions with toxemic shock. Of recent, increasing cases of anthrax have been reported in Nigeria
warranting heightened surveillance. A patient with skin lesions suggestive of cutaneous anthrax and toxic manifestations is
reviewed to emphasize the need for a high index of suspicion.
Case report: A 14-year-old boy presented with skin lesions of one month involving the hands, face, and legs, left lower limb
swelling of two weeks, fever of 10 days, and fast breathing of five days duration. There was a positive history of contact with
cattle carcasses at the abattoir. He was febrile (38.1o c), mildly pale, and mildly dehydrated, oxygen saturation was 95%. He
was tachypnoeic and tachycardic with a low-volume pulse. There was extensive left lower limb swelling, a raised necrotic
ulcer with a black surface on the calf, measuring 9cmx5cm with serosanguinous discharge, and another confluent vesicular
lesion on the anterolateral aspect of the left leg measuring 8cmx6cm. Differential diagnoses considered were cellulitis,
osteomyelitis, leishmaniasis, and malignancy.
Result, treatment & outcome: His packed cell volume was 33%, retroviral screening, and hepatitis screening were nonreactive, and erythrocyte sedimentation rate was 3mm/hr. Leg X-ray was normal. Other investigations could not be done due to financial constraints and the patient’s demise. He received intravenous (IV) fluid, IV ceftriaxone, IV metronidazole, tetanus toxoid, and antiseptic wound dressing. He succumbed to the illness 72 hours later. Anthrax was considered after the patient's demise due to the type of skin lesion and progression of the illness in line with the standard case definition.
Conclusion: Cutaneous anthrax with systemic manifestations should be considered as a probable diagnosis in patients with
typical skin lesions and toxic features.