Cutaneous Anthrax Associated With Microangiopathic Hemolytic Anemia and Coagulopathy in a 7-Month-Old Infant

Abstract

A 7-month-old infant with cutaneous anthrax developed severe systemic illness despite early treatment with antibiotics. The infant displayed severe microangiopathic hemolytic anemia with renal involvement, coagulopathy, and hyponatremia. These findings are unusual with cutaneous anthrax, but have been described in illness resulting from spider toxin and may delay correct diagnosis. The systemic manifestations of the disease persisted for nearly a month despite corticosteroid therapy, but resolved.

Sepsis and Pathophysiology of Anthrax in a Nonhuman Primate Model

“…Data from case reports of the 2001 bioterrorism victims were consistent with either overt 2,5 or probable DIC. 3 These clinical observations strongly indicate that procoagulant and inflammatory responses coincide with bacteremia and toxemia.…”

Pathology, Diagnosis, and Treatment of Anthrax in Humans

“…Systemic complications include sepsis, meningoencephalitis, and death (Kaya et al, 2002 ;Magui ñ a et al, 2005 ;Ozkurt et al, 2005 ). Microangiopathic hemolytic anemia is another systemic complication of cutaneous anthrax that has also been described (Freedman et al, 2002 ).…”

“…The differential diagnosis of cutaneous anthrax includes staphylococcal infection (erysipelas), gangrenous ecthyma, glanders, cat -scratch disease, diphtheria, typhus and other rickettsiosis, rat bite fever, syphilitic chancre, cutaneous plague, tularemia, cutaneous 254 Chapter 13 Pathology, Diagnosis, and Treatment of Anthrax in Humans tuberculosis, leprosy, blastomycosis, sporotrichosis, cutaneous zygomycosis, orf, cowpox, insect bites, and vasculitis (Freedman et al, 2002 ;Irmak et al, 2003 ;Karahocagil et al, 2008 ;Kaya et al, 2002 ;Magui ñ a et al, 2005 ;Onc ü l et al, 2002 ;Smego et al, 1998 ). However, the most important clue to the diagnosis of anthrax is the development of a painless ulcer surrounded by a zone of edema.…”

Care of Children in the Event of Bioterrorism

“…Spores of Bacillus anthracis at his mother's workplace most probably led to his cutaneous infection. Spores on hands of some workers probably entered his skin via inapparent skin abrasion on an exposed area [32].…”

“…For this reason infants and young children with even presumptive diagnosis of cutaneous anthrax should be admitted to the hospital. After appropriate cultures and investigations, they should receive intravenous antibiotic therapy and be monitored closely for electrolyte and hematologic complications [32].…”