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Periocular cutaneous anthrax in Jimma Zone, Southwest Ethiopia: a case series.

Gelaw Y, Asaminew T - BMC Res Notes (2013)

Bottom Line: All the three patients responded to intravenous antibiotics, and the lesion resolved leaving scars which caused cicatricial ectropion in all cases.Anthrax is a rare disease but should be considered in the differential diagnosis of ulcerative (and eschar forming) preseptal cellulitis with a history of contact with anthrax-infected animals or animal products.Furthermore, cicatrization of the eyelids, one of the sequelae of periocular cutaneous anthrax, should be addressed.

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Affiliation: Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, PO Box: 440, Jimma, Ethiopia. dryeshi@yahoo.com

ABSTRACT

Background: Anthrax is a zoonotic disease caused by Bacillus anthracis. Naturally occurring human infection is rare and is generally the result of contact with anthrax-infected animals or animal products.

Case presentation: We examined three patients who had contact with presumed anthrax-infected animal and/or its product and presented with preseptal cellulitis with a localized itchy erythematous papule of the eyelid and non-pitting periorbital edema, followed by ulceration and dark eschar formation. All the three patients responded to intravenous antibiotics, and the lesion resolved leaving scars which caused cicatricial ectropion in all cases.

Conclusion: Anthrax is a rare disease but should be considered in the differential diagnosis of ulcerative (and eschar forming) preseptal cellulitis with a history of contact with anthrax-infected animals or animal products. Furthermore, cicatrization of the eyelids, one of the sequelae of periocular cutaneous anthrax, should be addressed. Urgent case report to the local zoonotic disease and infection control body and other responsible authorities is recommended.

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Black eschar with reduction of periorbital edema.
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Figure 4: Black eschar with reduction of periorbital edema.

Mentions: On examination, he had diffuse edema on the left upper lid, lower lid and left part of the face with dark ulcer on the upper and lower lids. Visual acuity and other ocular examination were difficult initially. The temperature was 38.8°C. He took Augmentin 625 mg PO TID for 24 hours prior to presentation. The patient was admitted and started on intravenous ceftriaxone 1 gm BID and cloxacilline 500 mg QID. After 2 days there was mild decrement of the edema and the skin lesion became more discernable, thus doxycycline 100 mg PO BID was given. Black eschar began to form subsequently with resolution of the edema as seen in Figure 4. After 1 month of treatment, there was inter-palpebral height shortening with scarring resulting in difficulty of opening the eye lids. Mild ectropion on the lower eye lid was also present. The patient will be followed until the scar is stabilized enough to do skin graft.


Periocular cutaneous anthrax in Jimma Zone, Southwest Ethiopia: a case series.

Gelaw Y, Asaminew T - BMC Res Notes (2013)

Black eschar with reduction of periorbital edema.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750427&req=5

Figure 4: Black eschar with reduction of periorbital edema.
Mentions: On examination, he had diffuse edema on the left upper lid, lower lid and left part of the face with dark ulcer on the upper and lower lids. Visual acuity and other ocular examination were difficult initially. The temperature was 38.8°C. He took Augmentin 625 mg PO TID for 24 hours prior to presentation. The patient was admitted and started on intravenous ceftriaxone 1 gm BID and cloxacilline 500 mg QID. After 2 days there was mild decrement of the edema and the skin lesion became more discernable, thus doxycycline 100 mg PO BID was given. Black eschar began to form subsequently with resolution of the edema as seen in Figure 4. After 1 month of treatment, there was inter-palpebral height shortening with scarring resulting in difficulty of opening the eye lids. Mild ectropion on the lower eye lid was also present. The patient will be followed until the scar is stabilized enough to do skin graft.

Bottom Line: All the three patients responded to intravenous antibiotics, and the lesion resolved leaving scars which caused cicatricial ectropion in all cases.Anthrax is a rare disease but should be considered in the differential diagnosis of ulcerative (and eschar forming) preseptal cellulitis with a history of contact with anthrax-infected animals or animal products.Furthermore, cicatrization of the eyelids, one of the sequelae of periocular cutaneous anthrax, should be addressed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, PO Box: 440, Jimma, Ethiopia. dryeshi@yahoo.com

ABSTRACT

Background: Anthrax is a zoonotic disease caused by Bacillus anthracis. Naturally occurring human infection is rare and is generally the result of contact with anthrax-infected animals or animal products.

Case presentation: We examined three patients who had contact with presumed anthrax-infected animal and/or its product and presented with preseptal cellulitis with a localized itchy erythematous papule of the eyelid and non-pitting periorbital edema, followed by ulceration and dark eschar formation. All the three patients responded to intravenous antibiotics, and the lesion resolved leaving scars which caused cicatricial ectropion in all cases.

Conclusion: Anthrax is a rare disease but should be considered in the differential diagnosis of ulcerative (and eschar forming) preseptal cellulitis with a history of contact with anthrax-infected animals or animal products. Furthermore, cicatrization of the eyelids, one of the sequelae of periocular cutaneous anthrax, should be addressed. Urgent case report to the local zoonotic disease and infection control body and other responsible authorities is recommended.

Show MeSH
Related in: MedlinePlus