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Cutaneous Anthrax and its Mimics

Cutaneous Anthrax

The primary lesion of cutaneous anthrax is a painless, pruritic papule that appears one to seven days after inoculation. Within one to two days, small vesicles or a larger, 1- to 2-cm vesicle forms that is filled with clear or serosanguineous fluid. As the vesicle enlarges, satellite vesicles may form. Fluid within the vesicles may contain numerous, large gram-positive bacilli. As the lesion matures, a prominent, non-pitting edema surrounds it. Eventually, the vesicle ruptures, undergoes necrosis, and enlarges, forming a painless ulcer covered by the characteristic black eschar. Symptoms include low-grade fever and malaise. Regional lymphadenopathy is present early on.

Used with Permission from the
Center for Public Health
and Disasters of California


Differential Diagnosis of Ulceroglandular Syndromes

Cutaneous anthrax
Cutaneous leishmaniasis
Cat-scratch disease
Herpes simplex infection
Lymphogranuloma venereum
Staphylococcal/streptococcal adenitis

Differential Diagnosis of an Ulcer and Eschar

Cutaneous anthrax
Antiphospholipid antibody syndrome
Aspergillosis and mucormycosis
Brown recluse spider bite
Coumarin and heparin necrosis
Cutaneous leishmaniasis
Ecthyma and ecthyma grangrenosum
Factitious ulcer
Rickettsial pox and typhus

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