Images in Clinical Medicine
Cutaneous Anthrax Infection
N Engl J Med 2001; 345:1611November 29, 2001
- Article
Figure 1 A seven-month-old male infant was hospitalized with a two-day history of swelling of the left arm and a weeping lesion at the left elbow (Panel A). The patient was afebrile but had a 2-cm open sore, with surrounding erythema and induration, that oozed clear yellow fluid. There was nontender swelling and erythema of the entire arm. The white-cell count was 28,100 per cubic millimeter. Incision and drainage of the lesion produced 10 ml of dark red fluid. A coronal, T1-weighted sequence from a magnetic resonance imaging study (Panel B) demonstrated diffuse, severe edema of the subcutaneous tissues extending from the shoulder to the hand. The working diagnosis was Loxosceles reclusa spider bite with superimposed cellulitis. The child was treated with ampicillin–sulbactam and clindamycin. He had been at his mother's office at a television network three days before admission, two weeks after the destruction of the World Trade Center in New York. After anthrax exposure was reported at another television network, two punch biopsies of the lesion were performed. Polymerase chain reaction and immunostaining for Bacillus anthracis were positive. The patient was discharged in stable condition.
Kevin Joseph Roche, M.D.
Mary Wu Chang, M.D.
Herbert Lazarus, M.D.
New York University Medical Center, New York, NY 10016- Citing Articles (14)
Citing Articles
1
Richard S. Vetter. (2009) The Distribution of Brown Recluse Spiders in the Southeastern Quadrant of the United States in Relation to Loxoscelism Diagnoses. Southern Medical Journal 102:5, 518-522
CrossRef2
S.S. Koçer, M. Matic, M. Ingrassia, S.G. Walker, E. Roemer, G. Licul, S.R. Simon. (2008) Effects of anthrax lethal toxin on human primary keratinocytes. Journal of Applied Microbiology 105:6, 1756-1767
CrossRef3
Edwin J. Masters, Chelsea N. Grigery, Reid W. Masters. (2008) STARI, or Masters Disease: Lone Star Tick–Vectored Lyme-like Illness. Infectious Disease Clinics of North America 22:2, 361-376
CrossRef4
Batya B Davidovici, Ronni Wolf. (2007) Emergencies in dermatology: diagnosis, classification and therapy. Expert Review of Dermatology 2:5, 549-562
CrossRef5
David L. Swanson, Richard S. Vetter. (2006) Loxoscelism. Clinics in Dermatology 24:3, 213-221
CrossRef6
Swanson, David L., Vetter, Richard S., . (2005) Bites of Brown Recluse Spiders and Suspected Necrotic Arachnidism. New England Journal of Medicine 352:7, 700-707
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Richard S. Vetter, G. B. Edwards, Louis F. James. (2004) Reports of Envenomation by Brown Recluse Spiders (Araneae: Sicariidae) Outnumber Verifications of Loxosceles Spiders in Florida. Journal of Medical Entomology 41:4, 593-597
CrossRef8
Richard S Vetter, Paula E Cushing, Rodney L Crawford, Lynn A Royce. (2003) Diagnoses of brown recluse spider bites (loxoscelism) greatly outnumber actual verifications of the spider in four western American states. Toxicon 42:4, 413-418
CrossRef9
Richard S. Vetter. (2003) Brown Recluse Spider Bite Diagnoses and Lawsuits. Pediatric Emergency Care 19:4, 291-292
CrossRef10
Richard S. Vetter, Diane K. Barger. (2002) An Infestation of 2,055 Brown Recluse Spiders (Araneae: Sicariidae) and No Envenomations in a Kansas Home: Implications for Bite Diagnoses in Nonendemic Areas. Journal of Medical Entomology 39:6, 948-951
CrossRef11
Richard S. Vetter, Sean P. Bush. (2002) Reports of Presumptive Brown Recluse Spider Bites Reinforce Improbable Diagnosis in Regions of North America Where the Spider Is Not Endemic. Clinical Infectious Diseases 35:4, 442-445
CrossRef12
C.Anthony Hart, Nicholas J Beeching. (2002) A spotlight on anthrax. Clinics in Dermatology 20:4, 365-375
CrossRef13
Mary Lou Manning, Fred M. Henretig, Kathleen Ryan Kuntz. (2002) Bioterrorism. Journal for Specialists in Pediatric Nursing 7:2, 49-50
CrossRef14
(2002) Cutaneous Anthrax Infection. New England Journal of Medicine 346:12, 945-946
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