Home » Volumes » Volume 53 - 2020 » Surgical Treatment of Cutaneous Anthrax

Surgical Treatment of Cutaneous Anthrax

Changsong Zhao1, Qiang Zhang1, Yao Zhang1

1Capital Medical University, Beijing Ditan Hospital, Department of Orthopedics, Beijing, China.

DOI: 10.1590/0037-8682-0062-2019

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 fasciotomy23.

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


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


1. Gilliland G, Starks V, Vrcek I, Gilliland C. Periorbital cellulitis due to cutaneous anthrax. Int Ophthalmol. 2015;35(6):843-5. [ Links ]

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). [ Links ]

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. [ Links ]

Received: February 02, 2019; Accepted: May 08, 2019

Corresponding author: Dr. Qiang Zhang. e-mail:765926411@qq.com

Conflict of Interest: The authors declare no conflict of interest.